The Difficult Ureter

Clinical and Radiographic Characteristics Associated With Upper Urinary Tract Access at the Time of Ureteroscopic Stone Treatment

Boyd R. Viers, Lyndsay D. Viers, Nathan C. Hull, Theodore J. Hanson, Ramila A. Mehta, Eric J. Bergstralh, Terri J. Vrtiska, Amy Krambeck

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the association between clinicoradiographic features and need for prestenting (PS) because of inability of the ureter to accommodate the ureteroscope, or ureteral access sheath, at the time of stone treatment.

MATERIALS AND METHODS: From 2009 to 2013, 120 consecutive nonstented patients underwent ureteroscopic stone treatment with preoperative computerized tomography urogram. Acute stone events with obstruction or infection were excluded. Preoperative radiographic imaging underwent radiologist review. Clinicoradiographic features were characterized, and multivariable logistic regression models were used to identify covariates independently associated with need for PS.

RESULTS: Of the 154 renal units treated, 25 (16%) required PS for failed primary access. PS ureters were less likely to have a history of prior ipsilateral ureteral stent (4% vs 31%) or surgery (8% vs 36%; P <.05). Radiographically, PS ureters had a narrower ureteropelvic junction (4 mm vs 5 mm) and were more likely to have <50% ureteral opacification on computerized tomography urogram (32% vs 9%; P <.05). On multivariable analysis, prior ipsilateral ureteral stent (odds ratio [OR] = 0.11) and stone surgery (OR = 0.15) reduced the need for PS; meanwhile, <50% ureteral opacification (OR = 4.41) was independently associated with an increased risk of access failure.

CONCLUSION: We report a 16% incidence of access failure requiring PS at time of ureteroscopy. Clinically, there was an 89% and 85% risk reduction in the need for PS with prior history of ipsilateral ureteral stent or surgery. Radiographically, there was a 4.4-fold increased risk of PS with <50% ureteral opacification. Accordingly, our findings may assist in counseling and operative management of the difficult ureter.

Original languageEnglish (US)
Pages (from-to)878-884
Number of pages7
JournalUrology
Volume86
Issue number5
DOIs
StatePublished - Nov 1 2015
Externally publishedYes

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Ureter
Urinary Tract
Stents
Urography
Odds Ratio
Logistic Models
Ureteroscopes
Tomography
Ureteroscopy
Risk Reduction Behavior
Therapeutics
Counseling
Kidney
Incidence
Infection

ASJC Scopus subject areas

  • Urology

Cite this

The Difficult Ureter : Clinical and Radiographic Characteristics Associated With Upper Urinary Tract Access at the Time of Ureteroscopic Stone Treatment. / Viers, Boyd R.; Viers, Lyndsay D.; Hull, Nathan C.; Hanson, Theodore J.; Mehta, Ramila A.; Bergstralh, Eric J.; Vrtiska, Terri J.; Krambeck, Amy.

In: Urology, Vol. 86, No. 5, 01.11.2015, p. 878-884.

Research output: Contribution to journalArticle

Viers, Boyd R. ; Viers, Lyndsay D. ; Hull, Nathan C. ; Hanson, Theodore J. ; Mehta, Ramila A. ; Bergstralh, Eric J. ; Vrtiska, Terri J. ; Krambeck, Amy. / The Difficult Ureter : Clinical and Radiographic Characteristics Associated With Upper Urinary Tract Access at the Time of Ureteroscopic Stone Treatment. In: Urology. 2015 ; Vol. 86, No. 5. pp. 878-884.
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AU - Viers, Boyd R.

AU - Viers, Lyndsay D.

AU - Hull, Nathan C.

AU - Hanson, Theodore J.

AU - Mehta, Ramila A.

AU - Bergstralh, Eric J.

AU - Vrtiska, Terri J.

AU - Krambeck, Amy

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N2 - OBJECTIVE: To evaluate the association between clinicoradiographic features and need for prestenting (PS) because of inability of the ureter to accommodate the ureteroscope, or ureteral access sheath, at the time of stone treatment.MATERIALS AND METHODS: From 2009 to 2013, 120 consecutive nonstented patients underwent ureteroscopic stone treatment with preoperative computerized tomography urogram. Acute stone events with obstruction or infection were excluded. Preoperative radiographic imaging underwent radiologist review. Clinicoradiographic features were characterized, and multivariable logistic regression models were used to identify covariates independently associated with need for PS.RESULTS: Of the 154 renal units treated, 25 (16%) required PS for failed primary access. PS ureters were less likely to have a history of prior ipsilateral ureteral stent (4% vs 31%) or surgery (8% vs 36%; P <.05). Radiographically, PS ureters had a narrower ureteropelvic junction (4 mm vs 5 mm) and were more likely to have <50% ureteral opacification on computerized tomography urogram (32% vs 9%; P <.05). On multivariable analysis, prior ipsilateral ureteral stent (odds ratio [OR] = 0.11) and stone surgery (OR = 0.15) reduced the need for PS; meanwhile, <50% ureteral opacification (OR = 4.41) was independently associated with an increased risk of access failure.CONCLUSION: We report a 16% incidence of access failure requiring PS at time of ureteroscopy. Clinically, there was an 89% and 85% risk reduction in the need for PS with prior history of ipsilateral ureteral stent or surgery. Radiographically, there was a 4.4-fold increased risk of PS with <50% ureteral opacification. Accordingly, our findings may assist in counseling and operative management of the difficult ureter.

AB - OBJECTIVE: To evaluate the association between clinicoradiographic features and need for prestenting (PS) because of inability of the ureter to accommodate the ureteroscope, or ureteral access sheath, at the time of stone treatment.MATERIALS AND METHODS: From 2009 to 2013, 120 consecutive nonstented patients underwent ureteroscopic stone treatment with preoperative computerized tomography urogram. Acute stone events with obstruction or infection were excluded. Preoperative radiographic imaging underwent radiologist review. Clinicoradiographic features were characterized, and multivariable logistic regression models were used to identify covariates independently associated with need for PS.RESULTS: Of the 154 renal units treated, 25 (16%) required PS for failed primary access. PS ureters were less likely to have a history of prior ipsilateral ureteral stent (4% vs 31%) or surgery (8% vs 36%; P <.05). Radiographically, PS ureters had a narrower ureteropelvic junction (4 mm vs 5 mm) and were more likely to have <50% ureteral opacification on computerized tomography urogram (32% vs 9%; P <.05). On multivariable analysis, prior ipsilateral ureteral stent (odds ratio [OR] = 0.11) and stone surgery (OR = 0.15) reduced the need for PS; meanwhile, <50% ureteral opacification (OR = 4.41) was independently associated with an increased risk of access failure.CONCLUSION: We report a 16% incidence of access failure requiring PS at time of ureteroscopy. Clinically, there was an 89% and 85% risk reduction in the need for PS with prior history of ipsilateral ureteral stent or surgery. Radiographically, there was a 4.4-fold increased risk of PS with <50% ureteral opacification. Accordingly, our findings may assist in counseling and operative management of the difficult ureter.

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