Comparison of Ureteroscopy in fresh versus recurrent cases of stone ureter

Urolithiasis is a common cause of both urology outpatient clinic and emergency room encounters. Approximately 75-90% of ureteral stones pass spontaneously. from this point of view other managements of ureteric stones either ESWL, ureteroscopy or open surgery according to location, site, size, and density. Ureteroscopy is commonly used to diagnose and treat kidney and ureteral stones, ureteral strictures, and urothelial cancers. Semirigid URS is the gold standard of treatment for ureteral stones. High success rates and low morbidity have been reported in semirigid URS. but complications still occur in some cases. The possibility to predict their occurrence should influence patient advisement and better case selection. there are many predictors of successful URS as age, gender, previous ESWL, and stone character. In addition, the impacted stone is a risk factor, and it is described in the literature as ureteral wall thickness, higher grades of hydronephrosis, ureteral stricture, polyp, inflammatory reaction, and difficulty to introduce the guide wire. the literature is very poor in illustrating the previous procedures as a predictor of successful URS only seen in very few original articles as second-time URS after any procedure decreases the rate of success, so it is a point of research that Amr Moustafa aims to clarify. Amr Moustafa will conduct a prospective study to evaluate the outcomes of URS for stones in the fresh and recurrent cases.

Inclusion Criteria:

• • all cases with middle and lower ureteric stone candidate for endoscopy.

  • Stone 15mm or less.

Exclusion Criteria:

• • Patients with a ureteral stent.

  • Patient refusing participation.
  • Pregnant woman.
  • Active urinary tract infection.
  • Comorbidities prevent intervention including bleeding tendency or uncorrectable coagulation profile.

.4. 2- Study subjects:

1. Inclusion criteria:

   • all cases with middle and lower ureteric stone candidate for endoscopy.
   • Stone 15mm or less.

2. Exclusion criteria:

   • Patients with a ureteral stent.
   • Patient refusing participation.
   • Pregnant woman.
   • Active urinary tract infection.
   • Comorbidities prevent intervention including bleeding tendency or uncorrectable coagulation profile.

3. Sample Size Calculation:

Based on previously reported frequency of primary failure of ureteocopy in case of recurrent stone that ranged between 1-37% (*reference)* a total sample size of 62 patients will be required ( 31 patients in each arm) with the following assumption; alpha error 5%, 80% power with 95% confidence interval