Relocation, laser dusting and suction (RELOADUS): An international collaborative observational study for laser management to prevent strictures of symptomatic impacted upper ureteric stones

Abstract

Background Ureteric stricture formation following ureteroscopy and laser management of stones is known. Objective To evaluate the feasibility, safety, stone clearance outcomes and rate of upper ureteric stricture formation after implementation of the Relocation, laser dusting and suction (RELOADUS) technique for the endoscopic management of impacted upper ureteric stones. Methods This is an international collaborative study recruiting 80 consecutive patients with impacted upper ureteric stones with a mean size of 7.2 mm ± 4.2. Patients were managed by relocation of impacted upper ureter stones, laser dusting and suction at multiple centres (intervention group). A control group ( n = 80) was identified from the databases of these centres to assess the outcome. Primary outcome of the study was the rate of ureteric stricture formation on follow-up. Key Findings and Limitations At a mean follow-up of 12.2 ± 5.9 months, the observed rate of upper ureteric stricture was lower in the intervention group than in the control group, although this difference did not reach statistical significance (1/80, 1.25% vs. 4/80, 5%; p = 0.367). Similarly, a higher rate of residual stone fragments was seen on follow-up imaging at 3 months in the control group ( p = 0.002). There were no differences in the duration of procedure or follow-up unscheduled admissions between the groups. Intervention RELOADUS is a technique where impacted upper ureteric stones are relocated into renal pelvis, dusted using laser and then suction applied to achieve complete clearance. Conclusions The RELOADUS technique appears to be a feasible and safe management strategy for impacted upper ureteric stones. By relocating impacted stones from the narrow ureter to the more capacious renal pelvis and utilising laser dusting with suction, the approach achieved high stone-free rates while aiming to reduce laser activation and instrumentation within the ureter. Larger prospective studies are required to confirm its effect on ureteric stricture formation.