Safety and efficacy of Mini-Percutaneous Nephrolithotomy in the treatment of large impacted Proximal Ureteral Stones
Journal Title: Journal of Surgery and Surgical Research - Year 2018, Vol 4, Issue 2
Abstract
The management of large, impacted upper ureteric calculi remains challenging for urologists. Various treatment options include extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopic lithotripsy (URSL), percutaneous nephrolithotripsy (PCNL), laparoscopic and open ureterolithotomy. ESWL has poor overall success rate in the treatment of large stones with a significant possibility of residual fragments. Semi-rigid or flexible ureterorenoscopy with Holmium: YAG laser lithotripsy (URSL) has a stone-free rate of 89-100% in managing proximal ureteral calculi [1-7]. However, large and impacted proximal ureteral stones are difficult to approach. PCNL was introduced as an alternative treatment for large renal and proximal ureteric stones and achieved success in the 1980s [8]. The modified version of PCNL using a miniature endoscope by way of a small access tract, can be routinely performed to manage stones in the kidney and proximal ureter [9]. PCNL has been widely accepted as the treatment of choice for renal stones since the 1980s and is shown to have a higher success rate compared to other minimally invasive procedures, thus became the gold standard treatment for complex and large renal stones. However, bleeding and fever are the common complications. Laparoscopic ureterolithotomy [10,11], is associated with a shorter period of convalescence when compared to an open procedure, but is associated with a higher learning curve. Open ureterolithotomy is indicated for failure of all minimally invasive modalities, in presence of a concomitant open procedure, and the presence of large impacted stone where patients don't consent for multiple procedures [12]. So, to evaluate the efficacy and safety of mini-PCNL in impacted proximal ureteral calculi, we started this hospital based study (2014-2018) to use mini-PCNL (14F semi-rigid nephroscope via a 16-Fr percutaneous tract) for the treatment of large (≥15mm) impacted proximal ureteral calculi (from PUJ to lower border of L4 vertebra).
Authors and Affiliations
FA Najar
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- EP ID EP532379
- DOI 10.17352/2455-2968.000053
- Views 52
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Safety and efficacy of Mini-Percutaneous Nephrolithotomy in the treatment of large impacted Proximal Ureteral Stones
The management of large, impacted upper ureteric calculi remains challenging for urologists. Various treatment options include extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopic lithotripsy (URSL), percutane...
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