Introduction: Ureter stones leading to severe pain and urosepsis are usually treated by emergency primary ureteral stenting. However, this intervention can significantly change the location of the stone, potentially also changing the preferred method and/or technical aspects of definitive treatment. We analyzed stone location changes and consequences after emergency ureteral stent insertion prior to secondary ureterorenoscopy. Methods: We performed a retrospective analysis of stone locations in 649 patients with a mean age of 52 ± 16 years who were treated with ureterorenoscopy for symptomatic stones from May 2016 to December 2019. All patients with single unilateral ureterolithiasis undergoing definitive stone treatment by secondary ureterorenoscopy were included. In 469 patients, ureteral stone localization before emergency ureteral stenting and at subsequent ureterorenoscopy was evaluated. Additionally, the use of flexible ureterorenoscopy for complete stone removal was also recorded. Results: Inadvertent repositioning of ureteral stones with a mean diameter of 6.9 (±3.1) mm after ureteral stenting was observed in 45.6%. 119 (25.4%) ureteral stones were displaced back into the kidney. Proximal stones showed a particularly high incidence of repositioning into the renal pelvis (42%, p < 0.05). The majority of cases required the use of flexible ureterorenoscopy showed a primary proximal ureteral localization (60 of 85 patients, 70.5%). Discussion/Conclusion: Emergency ureteral stenting for ureterolithiasis may change the location of a stone, potentially affecting therapy planning, particularly in the case of proximal stones. Imaging control prior to definitive stone treatment is thus especially advisable for proximal ureteral stones.

1.
Reicherz
A
,
Sahin
R
,
Häuser
L
,
Noldus
J
,
Bach
P
.
An empirical study on the operative treatment of symptomatic urolithiasis in Germany
.
Urol Int
.
2021
;
105
(
3–4
):
240
6
. .
2.
Türk
C
,
Neisius
A
,
Petřík
A
,
Seitz
C
,
Thomas
K
,
Skolarikos
A
.
EAU Guidelines on urolithiasis 2020
.
European Association of Urology Guidelines 2020 Edition
.
The European Association of Urology Guidelines Office
;
2020
.
3.
Eismann
L
,
Kretschmer
A
,
Bader
MJ
,
Kess
S
,
Stief
CG
,
Strittmatter
F
.
Adherence to guidelines in the management of urolithiasis: are there differences among distinct patient care settings?
World J Urol
.
2021 Aug
;
39
(
8
):
3079
87
. .
4.
Pratsinis
M
,
Tekin
AC
,
Zumstein
V
,
Güsewell
S
,
Schmid
HP
,
Abt
D
,
Urinary stone location with ureteral stents in place: always on the move, and not where you would expect
.
Urol J
.
2020 Nov 18
;
17
(
6
):
667
70
.
5.
AWMF: S2k-Leitlinie zur Diagnostik, Therapie und Metaphylaxe der Urolithiasis. AWMF Registernummer: 043–025
.
2018
. https://www.awmf.org/uploads/tx_szleitlinien/043-025L_S2k_Diagnostik_Therapie_Metaphylaxe_Urolithiasis_2019-07_1.pdf.
6.
Baumgarten
L
,
Desai
A
,
Shipman
S
,
Eun
DD
,
Pontari
MA
,
Mydlo
JH
,
Spontaneous passage of ureteral stones in patients with indwelling ureteral stents
.
Can J Urol
.
2017 Oct
;
24
(
5
):
9024
9
.
7.
Kuebker
JM
,
Robles
J
,
Kramer
JJ
,
Miller
NL
,
Herrell
SD
,
Hsi
RS
.
Predictors of spontaneous ureteral stone passage in the presence of an indwelling ureteral stent
.
Urolithiasis
.
2019
;
47
(
4
):
395
400
. .
8.
Traxer
O
,
Thomas
A
.
Prospective evaluation and classification of ureteral wall injuries resulting from insertion of a ureteral access sheath during retrograde intrarenal surgery
.
J Urol
.
2013 Feb
;
189
(
2
):
580
4
. .
9.
Mckay
A
,
Somani
BK
,
Pietropaolo
A
,
Geraghty
R
,
Whitehurst
L
,
Kyriakides
R
,
Comparison of primary and delayed ureteroscopy for ureteric stones: a prospective non-randomized comparative study
.
Urol Int
.
2021
;
105
(
1–2
):
90
4
. .
10.
Lennon
GM
,
Thornhill
JA
,
Grainger
R
,
McDermott
TE
,
Butler
MR
.
Double pigtail ureteric stent versus percutaneous nephrostomy: effects on stone transit and ureteric motility
.
Eur Urol
.
1997
;
31
(
1
):
24
9
. .
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.