Treatment of ureterolithiasis with the use of percutaneous antegrade ureterolithotripsy

Abstract

Study purpose – to assess the possibility of percutaneous antegrade ureterolithotripsy as an alternative treatment for patients with large calculi of the proximal part of ureter. Patients and methods. Results of 75 mini percutaneous antegrade ureterolithotripsy with contact lithotripsy were studied. The mean size of the ureteral calculi was 1.8 ± 0.7 cm. The operations were performed with epidural anesthesia with intravenous sedation, in the patient's position “on the abdomen” in 62 (82.7 %) cases and in the patient's position “on the back” in 13 (17.3 %) cases. Puncture of the renal cavity system was performed with combined ultrasound and fluoroscopic guidance. Accesses were performed through the lower calices group in 14 (18.7 %) cases, through the middle calices group in 39 (52.0 %), and through the upper calices group in 22 (29.3 %) cases. Results. The mean time of mini percutaneous antegrade ureterolithotripsy was 58.5 ± 15.4 min, while the stone free rate was achieved in all 100% of patients. The mean level of hemoglobin drop was not more than 15.5 ± 5.4 GM/DL In the postoperative period, aggravation of pyelonephritis was noted in 8 (10.6 %) patients. Nephrostomy drainage followed percutaneous antegrade ureterolithotripsy in 24 (32.0 %) cases, nephrostomy drainage and internal ureteral JJ stent in 33 (44.0 %), and the operation was ended with a tubeless method with only ureteral JJ stent placement in 14 (18.7%) cases. Nephrostomy drainage, as well as ureteral stants (with tubeless method), were removed in 1–2 days. The mean period of postoperative stay of patients in the hospital was 2.3 ± 0.8 days. It was noted that antegrade fiberureteropyeloscopy is an extremely time-consuming and cost-demanding method, as an alternative to which may be percutaneous antegrade ureterolithotripsy with use of mini-nephroscope tubes. Conclusions. Analysis of urolithiasis treatment with the method of mini percutaneous antegrade ureterolithotripsy indicates that this method is an attractive direction in the treatment of patients with large calculi of the proximal parts of ureter that allows achievement of the full stone free rate state, time of surgical treatment and hospital stay for patients with this pathology reduction.

Keywords

• ureterolithiasis
• percutaneous lithotripsy
• mini percutaneous nephrolithotripsy