Laboratory Studies

Useful pre-operative laboratory stories include:

Coagulation factors
- Prothrombin time
- Activated partial thromboplastin time
- Platelet count
Urinalysis and urine culture
Standard preoperative laboratory workup
- CBC count
- Electrolyte levels
- Serum creatinine and BUN determination

Imaging Studies

Useful preoperative imaging studies depending on the clinical presentation may include the following:

Renal ultrasonography
IVP (once ubiquitous, now increasingly being phased out)
CT scan
- non-contrast (i.e. stone protocol)
- IV contrast with delay (i.e. Hematuria, Mass protocol)
MRI

Treatment & Management

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Grotas A, Grasso M. Endoluminal sonographic imaging of upper urinary tract: three-dimensional reconstruction. J Endourol. 2001 Jun. 15(5):485-8. [Medline].
Hudson RG, Conlin MJ, Bagley DH. Ureteric access with flexible ureteroscopes: effect of the size of the ureteroscope. BJU Int. 2005 May. 95(7):1043-4. [Medline].
Johnson GB, Fraiman M, Grasso M. Broadening experience with the retrograde endoscopic management of upper urinary tract urothelial malignancies. BJU Int. 2005 Mar. 95 Suppl 2:110-3. [Medline].
Johnson GB, Grasso M. Exaggerated primary endoscope deflection: initial clinical experience with prototype flexible ureteroscopes. BJU Int. 2004 Jan. 93(1):109-14. [Medline].
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Media Gallery

Flexible fiberoptic ureteropyeloscope.
Secondary endoscope deflection that allows lower-pole intrarenal access.
Plain radiograph that defines a large renal pelvic calculus with the flexible ureteroscope passed beyond the stone burden.
Ureteroscopic image of an impacted jack stone in the ureter. These calculi are composed of calcium oxalate monohydrate.
Ureteroscopic image of a papillary transitional cell carcinoma of the ureter.
A parapelvic cyst (star) causes splaying of the middle and lower pole calyces making access to a lower pole stone (arrow) very difficult.
Comparison of the semi-rigid Karl Storz ureteroscope and tip (above) with that of the ACMI MR6 endoscope (below).
Using secondary deflection, access to this lower pole stone burden is made possible.
The use of dilute contrast injected through the ureteroscope ensures adequate mapping and inspection of all calyces
Wireless ("no touch") ureteroscopy, laser lithotripsy and stone extraction technique performed with the digital ureteroscope.

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Table 1. Comparison of Complication Rates Associated With Ureteroscopy, Emphasizing the Noticeable Decrease in the Major Complication Rate With Greater Experience and Endoscope Miniaturization

	Blute, et al. ^[14]	Abdel-Razzak and Bagley ^[18]	Harmon, et al. ^[19]	Grasso ^[15]	Jiang, et al. ^[16]
Year	1988	1992	1997	2000	2007
Number of Procedures	346	290	209	1000	697
Minor Complications	(%)	(%)	(%)	(%)	(%)
Colic/pain	--	9.0	3.5	4.2	--
Fever	6.2	6.9	2.0	1.3	--
False passage	0.9	--	--	0.4	0.4
Hematuria Minor Prolonged	0.5 0.3	2.1 1.0	0 0	0.8 0.2
Extravasation	0.6	1.0	--	--	--
UTI	--	1.0	--	1.7	--
Pyelonephritis	--	--	--	1.0	--

Major Complications	(%)	(%)	(%)	(%)	(%)
Major perforation	4.6	1.7	1.0	0	0.3
Stricture	1.4	0.7	0.5	0.4	0.3
Avulsion	0.6	0	0	0	0
Urinoma	0.6	--	0	0	--
Urosepsis	0.3	0	0	0	--
CVA	--	--	0.5	0.1	--
DVT	--	--	--	0.1	--
MI	--	--	--	0.1	--

Table 2. New York University Experience With Ureteroscopic Treatment of Ureteral Calculi Using the Holmium:YAG Laser

Segment	Number of Cases	Mean Diameter, mm (range, mm)	Success Rate, First-Stage Treatment and Second -Stage Treatment
Proximal third	75	11.3 (30-5)	95% and 96%
Middle third	45	10.7 (60-5)	98% and 100%
Distal third	91	10.3 (50-4)	99% and 100%
Totals	211		97% and 99%

Table 3. New York University Experience With Ureteropyeloscopic Treatment of Intrarenal Calculi Using the Holmium:YAG Laser

Location	Number of Cases	Mean Diameter, mm (range, mm)	Success Rate, Treatment and Multistage Treatment
Upper pole	58	10.6 (35-4)	90% and 97%
Middle pole	30	11.1 (23-4)	90% and 93%
Lower pole	103	14.8 (40-3)	79% and 85%
Renal pelvic	37	20.5 (60-6)	78% and 95%
Totals	228		81% and 90%

Table 4. Review of Studies on Ureteroscopic Management of Upper Urinary Tract Calculi > 2 cm

STUDY	Date	Number of Patients	Mean Stone Diameter (mm)	Mean number of procedures	Stone Free (%)	Complications number (%)
Grasso et al.^[20]	1998	51	24.9	1.3	93	3 (3)
El-Anany et al.^[22]	2001	30	>20	1	77	3 (10)
Ricchiuti et al.^[23]	2007	23	30.9	1.4	74	0 (0)
Breda et al.^[24]	2008	15	22	2.3	93	3 (9)
Riley et al.^[25]	2009	22	30	1.8	91	4 (10)
Hyams et al.^[26]	2010	120	24	1.2	83	8 (6)
Takazawa et al.^[27]	2011	20	31	1.4	90	3 (5)
Cohen et al.^[21]	2012	145	29	1.6	87	5 (2)

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Author

Michael Grasso, III, MD Professor and Vice Chairman, Department of Urology, New York Medical College; Director, Living Related Kidney Transplantation, Westchester Medical Center; Director of Endourology, Lenox Hill Hospital

Michael Grasso, III, MD is a member of the following medical societies: American Medical Association, American Urological Association, Endourological Society, International Society of Urology, Medical Society of the State of New York, National Kidney Foundation, Society of Laparoendoscopic Surgeons

Disclosure: Received consulting fee from Karl Storz Endoscopy for consulting.

Coauthor(s)

Bobby S Alexander, MD Fellow in Endourology, Lenox Hill Hospital, Long Island Jewish Medical Center

Bobby S Alexander, MD is a member of the following medical societies: American Medical Association, American Urological Association, Endourological Society, Phi Beta Kappa, Golden Key International Honour Society

Disclosure: Nothing to disclose.

Paul Pyo, MD Staff Physician, Department of Urology, New York Medical College

Disclosure: Nothing to disclose.

G Blake Johnson, MD Consulting Staff, Middleton Urology Associates

G Blake Johnson, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association

Disclosure: Nothing to disclose.

Wayne L DeBeatham, MD Urologic Hospitalist, Department of Urology, Phelps Hospital

Wayne L DeBeatham, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, Endourological Society, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, Society of University Urologists

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Endourological Society Board of Directors; President Elect North Central Section of the American Urological Association<br/>Serve(d) as a speaker or a member of a speakers bureau for: Cook Medical.

Additional Contributors

Daniel B Rukstalis, MD Professor of Urology, Wake Forest Baptist Health System, Wake Forest University School of Medicine

Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science, American Urological Association

Disclosure: Nothing to disclose.

Acknowledgements

Dan Theodorescu, MD, PhD Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer Center

Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology

Disclosure: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership

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