Predictive Factors for Unsuccessful Holmium: YAG Laser Lithotripsy in the Retrograde Treatment of Proximal Ureteral Stones

Sulhan H., Tutuş A., Oktay C., Kalyenci B., Çoban F., Çift A.

Harran Üniversitesi Tıp Fakültesi Dergisi, cilt.23, sa.1, ss.115-122, 2026 (Hakemli Dergi)

Özet

Background: This retrospective study aimed to evaluate clinical and radiological parameters associated with unsuccessful outcomes of semi-rigid ureteroscopy  using holmium: YAG laser lithotripsy in patients with proximal ureteral stones.

Materials and Methods: A total of 212 patients who underwent semi-rigid URS for proximal ureteral stones between 2015 and 2025 were retrospectively analyzed. Patients were classified into three groups according to postoperative outcomes: Group 1 (stone-free, n=158), Group 2 (retropulsion, n=32), and Group 3 (residual fragments >3 mm, n=22). Demographic and stone-related parameters, including hydronephrosis grade, stone density, stone volume, and stone-to-renal pelvis distance, were compared statistically among the groups.

Results: The overall stone-free rate was 74.5%. Severe hydronephrosis was significantly more frequent in the retropulsion group compared to the stone-free group (46.9% vs. 12.7%, p<0.001), and was associated with a 6.1-fold increased risk of stone migration (95% CI: 2.6-14.1, p<0.001). Mean stone density was significantly higher in Group 2 compared to Group 1 (916±239 HU vs. 692±234 HU, p<0.001) and in Group 3 compared to Group 1 (868±191 HU vs. 692±234 HU, p=0.003). Median stone volume was also significantly greater in Group 2 than in Group 1 (459 mm³ vs. 168 mm³, p<0.001). Additionally, stone-to-renal pelvis distance was significantly shorter in Group 2 (7.5 mm vs. 27 mm, p<0.001).

Conclusions: High-grade hydronephrosis, increased stone density, larger stone volume, and shorter stone-to-renal pelvis distance are significantly associated with unsuccessful outcomes of semi-rigid ureteroscopic holmium: YAG laser lithotripsy in proximal ureteral stones. Preoperative evaluation of these parameters may help optimize surgical planning and patient counseling.