Perinephric fat stranding is associated with increased age and stone size but not with serum creatinine in patients with obstructing ureterolithiasis.

Previous reports show increased severity of perinephric fat stranding (PFS) with elevated serum creatinine in obstructing ureterolithiasis. We sought to investigate this association with our institution's patient population.We reviewed charts of patients diagnosed with obstructive ureterolithiasis or nephrolithiasis in our emergency department between January and October 2018. Patient demographics, lab results, and computed tomography (CT) imaging were reviewed. A blinded radiologist reviewed all CTs and graded hydronephrosis and PFS. Subjects were stratified by degree of PFS and compared via paired t-test, chi-squared test, univariate analysis, and multivariate analysis.We identified 141 patients; 114 had no-mild (Group 1) PFS, while 27 had moderate-severe (Group 2) PFS. Group 1 had a mean age of 56 (SD = 16.1) and mean stone size of 7.3 mm (SD = 4.22); 77% of the cohort had symptoms under 24 h. Group 2 was older with a mean age of 65 (SD = 16.2, p = 0.01) and mean stone size of 10.1 mm (SD = 6.07, p < 0.01); 50% had symptoms less than 24 h (p = 0.01). PFS did not correlate with change in serum creatinine. Univariate and multivariate analysis showed increasing age increased the odds of moderate-severe PFS by 3.5% (OR = 1.035, p < 0.05) while increased stone size increased the odds of moderate-severe PFS by 13.7% (OR = 1.137, p = 0.01).Although increased PFS correlated with increased age and stone size, no correlation was found with presenting creatinine or change in creatinine. Degree of PFS is likely a poor predictor of renal disease severity in acute ureterolithiasis.

Surgical repositioning with omentalisation of an exposed subcutaneous ureteral bypass shunting port in a cat.

Case summary: A 9-year-old, spayed, female domestic shorthair cat presented with an open wound approximately 1 cm in size with exposure of the left subcutaneous ureteral bypass (SUB) shunting port that was placed approximately 11 months before presentation. Primary closures were attempted twice before local wound management with omentalisation and repositioning of the port. The exposed port was lavaged topically with a polyhexanide and propylbetaine wound irrigation solution before omentalisation and repositioning, resulting in successful retention of the implant. Five months after revision and omentalisation, there was complete coverage and healing of the wound. Relevance and novel information: Adequate topical treatment, repositioning and omentalisation could be a successful treatment option for the uncommon complication of SUB shunting port extrusion secondary to resistant local infection originating from the urinary tract.

A case of post-renal acute kidney injury caused by bilateral ureterolithiasis.

Key Clinical Message: Bilateral ureterolithiasis is rare but can cause acute kidney injury (AKI). Clinicians should first examine for post-renal causes of AKI, even if the patient lacks subjective symptoms. Abstract: This letter describes a case of bilateral ureterolithiasis which presented with post-renal acute kidney injury (AKI) and was successfully treated by bilateral retrograde ureteric stenting. Clinicians should be aware of post-renal AKI caused by bilateral ureterolithiasis when acute worsening of renal function with oliguria is observed.

One and done: Feasibility and Safety of Primary Ureteroscopy in a Pediatric Population.

BACKGROUND: Pediatric urolithiasis has been increasing at rate of 4-10 % annually in the United States, most notably within adolescents and females. A significant number of patients will require surgical management of their stones. Primary ureteroscopy (URS) affords the opportunity to treat stones under a single anesthetic with lower re-treatment rates or anatomical and stone characteristic limitations compared to shockwave lithotripsy. Previous studies evaluating primary URS have been largely underpowered, are limited by stone location, and/or are not representative of the stone population in the United States. OBJECTIVES: Primary study outcomes were the success of primary URS and patient characteristics associated with success. Secondary outcomes were the stone-free rate (SFR), 30-day emergency department (ED) visits, 30-day readmissions, and complications. METHODS: We performed a retrospective cohort study of patients less than 18 years of age from 2011 to 2023 who underwent primary URS. Patients were excluded if a ureteral stent was placed prior to URS or diagnostic URS was performed. A successful primary URS was considered if access to the ureter was obtained and treatment of the stone(s) completed. In failed primary URS, a ureteral stent was placed for staged management. RESULTS: A total of 196 patients were included and primary URS was performed or attempted on 224 renal units. The median age was 15.8 (IQR 13.4-16.9) years and median follow up 8.4 (IQR 1.1-24.6) months. The success rate of primary URS was 79 %. No significant characteristics were appreciated for successful primary URS based on: overall age, <14 vs > 14 years of age, sex, body mass index, history of stones, history of endourologic procedures, preoperative alpha blockade, location of stone(s), multiple stones, type of URS, or acute treatment. In successful primary URS, the SFR was 88 % with stone size (p = 0.0001) the only predictor of having residual stones. The 30-day ED rate was 21.4 %, 30-day unplanned readmission rate was 12.5 %, and complication rate was 7.5 %. No long-term complications were appreciated. DISCUSSION: Our success of primary URS compares favorably to previously published literature. Our SFR rate, 30-day ED visits, 30-day unplanned readmission, and complication rates are similar to other studies. Limitations of the study are its retrospective design, selection bias, and intermediate follow-up. CONCLUSIONS: Primary URS can be completed safely in the majority of pediatric patients without any patient characteristics associated with success. We advocate for primary URS when possible due to the excellent SFR and potential of treating stones under a single anesthetic.

High risk and low prevalence diseases: Infected urolithiasis.

INTRODUCTION: Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE: This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence. DISCUSSION: Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care. CONCLUSIONS: An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Changes in patient perceptions regarding ChatGPT-written explanations on lifestyle modifications for preventing urolithiasis recurrence.

Purpose: Artificial Intelligence (AI) imitating human-like language, such as ChatGPT, has impacted lives throughout various multidisciplinary fields. However, despite these innovations, it is unclear how well its implementation will assist patients in clinical situations. We evaluated changes in patient perceptions regarding AI before and after reading a ChatGPT-written explanation. Materials and methods: In total, 24 South Korean patients receiving urolithiasis treatment were surveyed through questionnaires. The ChatGPT explanatory note was provided between the first and second questionnaires, detailing lifestyle modifications for preventing urolithiasis recurrence. The study questionnaire was the Korean version of the General Attitudes toward Artificial Intelligence Scale, including positive and negative attitude items. Wilcoxon signed-rank tests were accomplished to compare questionnaire scores before and after receiving the explanatory note. A linear regression analysis with stepwise elimination was used to assess variable (demographic data) accuracy in predicting outcomes. Results: There were significant differences between total negative questionnaire scores pre- and post-surveys of ChatGPT, but not in the positive scores. Among variables, only education level significantly influenced mean score differences in the negative questionnaires. Conclusions: The negative perception change among urolithiasis patients after receiving the explanatory note provided by the AI chatbot program was observed, evidencing that patients with lower education levels expressed a more negative response. The explanatory note provided by the AI chatbot program could provoke an adverse change in AI perception. Negative human responses must be considered to improve and adapt new technology in health care. Only through changing patient perspectives will upgraded AI technology integrate into medical healthcare.

Implementing routine use of self-removed ureteric stents on extraction strings: prospective patient-reported outcome measures and complications.

PURPOSE: Ureteric stents placed after ureteroscopy typically require cystoscopy for removal. Stent extraction strings allow the option of patient self-removal. This facilitates shorter stent dwell time, and cost-savings. Concerns regarding safety and limited evidence regarding patient acceptability are speculated reasons for infrequent clinical use of extraction strings. This study investigates our recent experience using routine self-removal of stents on extraction strings to provide evidence to address these concerns. METHODS: In February 2020, our hospital adopted a policy for self-removal of stents on extraction strings to be routine following ureteroscopy. This was influenced by motivation to improve service capacity for diagnostic flexible cystoscopy, hospital avoidance during the pandemic, perceived improvement for the patient experience, and cost-saving. Prospective clinical and patient-reported outcome data were collected and evaluated. RESULTS: There were 168 patients who had stents on extraction strings. Mean stent dwell time was 5.2 ± 1.8 days. Primary ureteroscopy was performed in 40.5%, and 59.5% had procedures using an access sheath. Self-removal at home was successful for 79% of patients. Stent dislodgement rate was 3.0% (5/168) and retained stents due to string detachment occurred in 1.8% (3/168). Almost all indicated they "would remove the stent on string again" (90%, 128/142) and the majority reported stent removal as "very easy" (61%, 87/142). Cost modelling estimates a total saving of AUD $148,869 per annum for routine use of extraction strings at our hospital. CONCLUSION: Our experience reflects that stent extraction strings may be used routinely with acceptable low complication rates, favourable patient experiences and associated cost savings.

Prevalence and implications of perinephric fluid on renal point-of-care ultrasound in the emergency department.

BACKGROUND: Point-of-care ultrasound (PoCUS) is commonly utilized in the setting of renal colic. The presence of perinephric fluid may be an overlooked finding associated with ureteral obstruction. Our aims were to determine the prevalence of perinephric fluid on emergency physician-performed PoCUS and to determine whether perinephric fluid was associated with stone size or urologic intervention. METHODS: This was a 12-month cross-sectional study at an academic emergency department (ED) that took place from January 1, 2022, to December 31, 2022. All adult ED patients ≥18 years of age who had a renal PoCUS examination performed were included. Patients with missing or inadequate PoCUS images were excluded. Investigators blinded to PoCUS images and interpretations performed chart review for demographic data and outcome variables, while separate investigators blinded to clinical data reviewed PoCUS images to assess for perinephric fluid and hydronephrosis. A chi-square analysis was used to determine significance of association between perinephric fluid and outcome variables (stone size, urologic intervention). RESULTS: There were 442 patients screened; 18 were excluded due to inadequate images and 4 were repeat visits of which only the initial visit was analyzed. Of the remaining 420 patients included, the prevalence of perinephric fluid was 6.2% (n = 26). Most patients (23/26) with perinephric fluid had final diagnoses consistent with ureterolithiasis. Hydronephrosis was present in 115 of the 420 patients (27.4%) and of these, 22 (19.1%) had perinephric fluid which was significantly associated with a need for urologic intervention; odds ratio (OR) 10.38 (95% CI 2.70-39.85), p < 0.01. Among the 67 patients with confirmed ureterolithiasis on computed tomography, perinephric fluid was associated with stone size ≥5 mm; OR 4.00 (95% CI 1.01-15.85), p = 0.04. CONCLUSION: The prevalence of perinephric fluid on emergency physician-performed renal PoCUS was 6.2% of all studies and 19.1% of patients with hydronephrosis. In the setting of ureterolithiasis, perinephric fluid was associated with larger stone size and need for urologic intervention.

Does the kidney actually swell during an acute urinary tract obstruction?

BACKGROUND: The appearance of renal swelling during an acute obstruction of the urinary tract could be caused by hydronephrosis or an increase of the parenchymal volume. To the best of our knowledge no studies have been performed regarding renal parenchymal volume change during an acute urinary tract obstruction. PURPOSE: To investigate the change in renal parenchymal volume during an acute urinary tract obstruction and to correlate any such volume change to the degree of secondary signs of obstruction. MATERIAL AND METHODS: In total, 20 patients with obstructive ureterolithiasis were retrospectively and randomly included. Two observers measured the parenchymal volume of the obstructed and the contralateral kidney in CT examinations before, during, and after obstruction. Hydronephrosis, hydroureter, perirenal stranding, and thickening of the renal fascia were graded and correlated to volume change. RESULTS: A decreased volume was noted after obstruction in the obstructed kidneys (-24%) (P < 0.0001) and in the contralateral kidneys (-5%) (P = 0.0110) with a positive correlation of change in volume (P = 0.011). The volume of the obstructed kidneys was larger than the contralateral kidneys during obstruction (P < 0.0001) but not after obstruction (P = 0.559). No significant difference in volume was found before compared to after obstruction. Secondary signs of obstruction did not correlate to volume change. CONCLUSION: The parenchymal volume increases in the obstructed kidneys as well as in the contralateral kidneys during obstruction. The increase in volume was larger in the obstructed kidneys compared to the contralateral kidneys. After obstruction the kidneys regained their original volume. Secondary signs did not correlate to volume change.

Facilitated ureteroscopy using DJ stent implantation in ureterolithiasis: A retrospective study.

OBJECTIVE: To investigate the impact of preoperative double J (DJ) stent insertion on outcomes of retrograde semi-rigid ureteroscopy (URS) in patients with upper small and medium sized ureteral stones. METHODS: Between April 2018 and September 2019, we retrospectively reviewed the medical register of Hillel Yaffe tertiary reference Centre (HYMC) for patients who had undergone retrograde semi-rigid URS for urolithiasis. Patients were separated into two groups depending on whether they accepted the DJ stent placement before URS (Group A) or not (Group B). Operating time, stone clearance rate, number of 'rescue' DJ stents, duration of 'rescue' stents, complication rate and requirement for repeat URS were compared between groups. RESULTS: 318 procedures undertaken in 290 patients were included (Group A, 83 procedures in 80 patiants; Group B, 235 procedures in 210 patients). By comparison with the non-stented group, patients in the preoperative DJ stented group had a higher stone clearance rate, lower complication rate, less need for postoperative 'rescue' DJ stent, lower duration of 'rescue' stent and lower re-operative URS requirement, including application of a flexible URS. CONCLUSION: Facilitated semi-rigid URS with upstream DJ stenting for small and medium size ureteral stones has favourable periprocedural outcomes compared with primary URS.

Risk factors for upper urinary tract uroliths and ureteral obstruction in cats under referral veterinary care in the United Kingdom.

BACKGROUND: Cats presenting with upper urinary tract uroliths (UUTUs) and ureteral obstruction ("obstructive UUTU") are typically younger than cats with idiopathic CKD that often have incidental nephroliths. HYPOTHESIS: Cats with upper urinary tract urolith have 2 clinical phenotypes; a more aggressive phenotype at risk of obstructive UUTU at a young age and a more benign phenotype in older cats, with reduced risk of obstructive UUTU. OBJECTIVES: Identify risk factors for UUTU and for obstructive UUTU. ANIMALS: Eleven thousand four hundred thirty-one cats were referred for care over 10 years; 521 (4.6%) with UUTU. METHODS: Retrospective VetCompass observational cross-sectional study. Multivariable logistic regression models were performed to identify risk factors for a diagnosis of UUTU vs no UUTU and additionally, obstructive UUTU vs nonobstructive UUTU. RESULTS: Risk factors for UUTU included female sex (odds ratio [OR] 1.6, confidence interval [CI] 1.3-1.9; P < .001), British shorthair, Burmese, Persian, Ragdoll or Tonkinese (vs non-purebred ORs 1.92-3.31; P < .001) breed and being ≥4 years (ORs 2.1-3.9; P < .001). Risk factors for obstructive UUTU were female sex (OR 1.8, CI 1.2-2.6; P = .002), having bilateral uroliths (OR 2.0, CI 1.4-2.9; P = .002) and age, with the odds of obstructive UUTU increasing as age at diagnosis of UUTU decreased (≥12 years, reference category; 8-11.9 years, OR 2.7, CI 1.6-4.5; 4-7.9 years, OR 4.1, CI 2.5-7.0; 0-3.9 years, OR 4.3, CI 2.2-8.6; P < 0.001). CONCLUSIONS AND CLINICAL IMPORTANCE: Cats diagnosed with UUTU at a younger age have a more aggressive phenotype with higher risk of obstructive UUTU compared to cats over 12 years of age diagnosed with UUTU.

DIFFERENT APPROACHES TO MANAGING UROLITHIASIS IN KIDNEY TRANSPLANT PATIENTS - A CASE REPORT.

Urolithiasis is a rare urologic complication after kidney transplantation, and its diagnosis and treatment can be challenging for clinicians. In our 52-year-old male patient, graft hydronephrosis was found six months after transplantation. The patient had recurrent urinary tract infections followed by macrohematuria and an increase in creatinine levels. Computerized tomography revealed a 13-mm diameter stone in the ureter of the transplanted kidney as the cause of obstruction. Percutaneous nephrostomy was placed in the graft to solve the obstruction. Initial endoscopic treatment with a retrograde approach failed. An antegrade approach through a previously placed nephrostomy was not successful either. By a repeated retrograde approach, laser lithotripsy was performed successfully. The patient has been monitored for six months and has stable graft function without hydronephrosis or stones. As in our patient's case, the diagnosis and treatment of urolithiasis in kidney transplant patients is challenging, and minimally invasive procedures are the treatment of choice.

Impact of Stone Localization before Emergency Ureteral Stenting on Further Stone Treatment.

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.

Factors Affecting the Outcome of Medical Treatment in Cats with Obstructive Ureteral Stones Treated with Tamsulosin: 70 Cases (2018-2022).

The incidence of diseases associated with feline ureteral obstruction is increasing; however, non-surgical treatment options are limited. This study evaluated the outcome of medical treatment in cats with obstructive ureteral stones treated with tamsulosin and identified potential factors predicting spontaneous stone passage. We retrospectively reviewed 70 client-owned cats treated at the Western Referral Animal Medical Center, Seoul, Korea, from 2018 to 2022. All the cats had obstructive ureterolithiasis and were treated using tamsulosin. The baseline characteristics of the cats, stone diameter and location, and stone passage outcomes were analyzed. Stone passage occurred in 22 cats; the remaining 48 cats showed no change in stone locations. Sex, creatinine, and diameter and location of stones were potential risk factors associated with successful stone passage, but age, weight, and side of the stone were not. No serious adverse events related to tamsulosin treatment were observed. This is the first study to identify the risk factors predictive of the spontaneous stone passage of cats with obstructive ureterolithiasis after tamsulosin treatment. Tamsulosin could be an alternative treatment for ureteral obstruction in male cats with smaller distal ureteral stones and low baseline serum creatinine levels. These findings could help develop guidelines for treating feline ureterolithiasis.

A pediatric case of ureterolithiasis due to cystinuria accompanied by acute appendicitis; a case report.

INTRODUCTION: Acute abdominal pain, a chief complaint frequently seen in the emergency department, can be triggered by a vast range of conditions. Although ureterolithiasis is a less common cause in children, renal colic can be caused by calculi due to hereditary metabolic diseases among patients in those age groups. PRESENTATION OF CASE: We report a 12-year-old girl with abdominal pain who was diagnosed with concurrent acute appendicitis and ureterolithiasis due to cystinuria. Acute appendicitis was successfully treated with cefmetazole, and the calculus was eliminated after adequate fluid loading. DISCUSSION: Synchronous acute appendicitis and ureterolithiasis is reported to be rare. Cystinuria is a hereditary metabolic stone-forming disease, and the first calculi can be detected in childhood. Increasing the solubility of cystine in the urine is required to prevent recurrent stone formation and accompanying complications. Urinalysis, ultrasound, and computed tomography coincidentally demonstrated two different acute pathological processes of ureterolithiasis and appendicitis. CONCLUSION: Careful physical and laboratory examination can help clinicians find coexisting etiologies of acute abdominal pain. Ureterolithiasis can be seen in children with hereditary disorders such as cystinuria. Early diagnosis of cystinuria and close monitoring may lead to a better long-term outcome.

Double-J stent placement during laparoscopic ureterolithotomy: the "seagull" technique.

OBJECTIVE: To present a new technique of double-j stent (DJ) placement during laparoscopic transperitoneal ureterolithotomy (LUL). PATIENTS AND METHODS: Following the extraction of the stone, a 6 French DJ open-end stent is prepared: two straight-tip hydrophilic guidewires are inserted into the appropriate lateral holes of the stent, as identified by the preoperative evaluation of the CT scan. Approximately 5 centimeters of each wire protrude from the proximal and distal ends of the stent to straighten its terminal curl, thus resembling the wings of a flying seagull. The remaining proximal portions of both guide wires are left within each guidewire dispenser. The two ends of the stent are grasped together in a U-fashion and inserted into the abdomen through a 10mm port. Once in the abdomen, the longer segment of the stent is inserted and pushed into the ureterotomy until it reaches the target site. The guide wire is then removed. The same procedure is repeated for the other end of the stent. A brief literature review on the currents techniques of laparoscopic DJ placement is also presented. RESULTS: Analyzing the outcomes of 21 LUL, the "seagull" technique is time-saving and safe. No perioperative complications were encountered. There is no risk of enlarging or tearing the ureterotomy and no need for patient replacement, extra cystoscopic or ureteroscopic procedures as well as of using modified guidewires and closed-tip stents. CONCLUSION: We described our step-by-step technique for DJ placement during LUL.

Massive Ureterolithiasis.

The authors present the case of a 40-year-old male who visited the emergency department with left-sided flank pain. He was found to have a 12 mm ureteropelvic stone and was provided parenteral analgesia before being admitted to the hospital for urology consultation. The presentation and diagnosis of his case along with treatment options against a backdrop of related studies are discussed.

When should we give up on expectant management for patients with proximal ureteral stones?

Background: Proximal ureteral stones (PUS) have relatively low rates of spontaneous expulsion. However, some patients do well on expectant management. Our aim was to compare risk factors for surgical intervention in patients with PUS who underwent primary intervention to those subjected to expectant management. Materials and methods: We retrospectively reviewed the medical charts of patients presented to the emergency room with symptoms of renal colic and underwent computerized tomography between August 2016 and August 2017. A total of 97 consecutive patients were identified with up to 10mm PUS. We collected patient demographics, clinical, and imaging data, and performed binary regression analysis for risk of intervention. Results: The average age was 49years (range 17-97) and average stone size was 7.1mm (range 3-10). Forty-one patients underwent immediate intervention while the remaining 56 patients were treated conservatively. Of the 56 patients treated conservatively, 26 underwent delayed intervention while 30 reported spontaneous stone expulsion. On univariate analysis of all 97 patients, statistically significant risk factors for intervention were found based on stone size, age, serum lymphocyte, platelet counts, and stone density. Of these risk factors, stone size ≥ 7mm (p = 0.012, odds ratio = 5.4) and platelet count ≤ 230K/µL (p = 0.027, odds ratio = 4.9) remained statistically significant on multivariate analysis. Conclusion: Stone size and platelet count were found to be risk factors for surgical intervention in patients with up to 10mm PUS. These findings may assist in identifying patients who are more suitable for conservative approach.

Prognostic factors for the safety and efficacy of retrograde laser lithotripsy: Data from a contemporary series of 155 consecutive patients with single and multiple lithiasis of the urinary tract.

Treatment of large and multiple stones located in the ureter and/or the kidney may be challenging. The aim of the current study was to evaluate the results and complications of retrograde endoscopic lithotripsy for stones located in the urinary tract and to determine prognostic factors for treatment outcome. From April 2017 to March 2020, eligible patients for the active treatment of ureterolithiasis with or without concomitant nephrolithiasis <20 mm were enrolled in the study. The prognostic factors for the stone free rate (SFR) after the 1st and subsequent sessions and overall complications were assessed. Patients were divided into single or multiple lithiasis groups (groups A and B respectively). A comparison between these two groups was then conducted. Overall, 237 stones were detected in 155 patients, representing a mean burden of 1.53 stone per patient. The mean total stone size was 14.7 mm, the initial SFR was 80% and the final SFR (after a mean of 1.23 session per patient) was 94.2%. The rate of complications was 26.4%. Multivariative analysis revealed that preoperative stenting and total stone size were independent prognostic factors of initial SFR, while no independent factors were determined for final SFR. Age, total size and stones in the lower calyx were independent factors for complications. In group A and B, 114 and 41 cases with solitary and multiple stones were included, respectively. Excluding operation time (P=0.002), no significant differences were recorded in terms of initial (P=0.255) and final SFR (P=0.056), hospital stay (P=0.308), mean number of treatments (P=0.757) and the rate of complications (P=0.218) between the two groups. In conclusion, retrograde endoscopic management of multiple lithiasis has a favorable outcome irrespective of stone location. Older patients with higher burdens and stones in the lower calyx should be treated with caution.