To investigate the safety, efficacy and feasibility of flexible ureteroscopic holmium laser lithotripsy without preoperative stent treating ureteral stone in tortuous ureter.

69 patients with ureteral stone in tortuous ureter retrospectively analyzed from March 2017 to December 2018 were enrolled and analyzed retrospectively. There were 30 males and 39 females, aged from 19 to 67 years old, with an average age of 45 years. The burden of ureteral stones was 0.6-3.0 cm, with an average of 1.1 cm. 24 patients with CT scan or intravenous urography showed tortuous ureter at the distal end of the ureteral calculi. The remaining 45 patients were found to have tortuous ureter during surgery. None of patients had preoperative ureteral stents. All preoperative urine cultures were negative. During the operation, the ureteral sheath was placed in the distal position of tortuous ureter, and the flexible ureteroscope was inserted into the ureter via sheath. Under continuous perfusion, the flexible ureteroscope was curved and pushed along the direction of the ureteral tortuosity. After through the tortuous position, the stone was pushed back to the kidney and crushed. For stones that could not be pushed, the stones were broken into pieces in the ureter and pushed back to the kidney for further pulverization. The ureteral stent was routinely placed at the end of surgery.

Among a total of 69 patients, 64 patients were treated by flexible ureteroscopic holmium laser lithotripsy without preoperative stent, and the success rate was 92.8%. Among the 5 patients who failed the operation, 1 patient underwent ureterolithotomy because the tortuous ureteral wall was weak, resulting in ureteral perforation by flexible ureteroscope; in 1 case, after the flexible ureteroscope passed through the tortuosity, the calculi could not be pushed back to kidney and the in situ lithotripsy could not be performed because of the huge size of calculi(3.0 cm), so ureterolithotomy were performed; 1 patient underwent PCNL because flexible ureteroscope could not pass through the tortuosity; 1 patient failed to insert the ureteral sheath because of ureterostenosis and underwent flexible ureteroscopic lithotripsy after stent implantation; 1 patient underwent stent implantation because of infective urine. Among the 64 patients who had successful operations, the stone clearance rate at the first month and the third month after surgery were 90.6% (58/64) and 95.3% (61/64). 4 patients had fever after the surgery, and 1 patient had renal area pain. Clavien classification gradeⅠ-Ⅱ.The complication rate was 7.8%.

Flexible ureteroscopic holmium laser lithotripsy without preoperative stent was a safe, effective and feasible treatment for patients with ureteral stone in tortuous ureter.

Ureteral stone; Tortuous ureter; Flexible ureteroscope; Holmium laser