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Urol Res (2011) 39:389392 DOI 10.1007/s00240-010-0351-9
ORIGINAL PAPER
An alternative treatment for high-burden ureteral stones: percutaneous antegrade ureteroscopy
Mustafa Okan Istanbulluoglu Mehmet Resit Goren
Tufan Cicek Bulent Ozturk Hakan Ozkardes
Received: 24 March 2010 / Accepted: 2 December 2010 / Published online: 31 December 2010 Springer-Verlag 2010
Abstract The treatment of large proximal ureteral stones continues to be controversial. We evaluated the antegrade percutaneous approaches for the proximal ureteral stones in our clinic. In this study, 73 percutaneous antegrade ureteroscopy (PAU) operations applied to proximal ureteral stones between February 2005 and December 2009 were included. The stones were located between ureteropelvic junction and 4th lumbar vertebra. PAUs were applied through appropriate calyx with the patients in prone position. During operations, amplatz dilatators were used for dilatation, and pneumatic lithotripter was used for stone fragmentation. Patients were evaluated according to their success rate, complications, hospitalization period, and preference of drainage tube etc. Patients mean age was 52.21 years, the mean stone diameter was 19.47 mm (range 1525), the mean stone burden was 283.76 49.12 mm2 (mean SD) (range 188.5392.7) and the mean hospitalization time 1.69 days. Single access done in 68 patients and two accesses were needed in 5 patients. Sixty-eight patients (93.1%) became stone-free. Nephrostomy tubes were placed in 12 patients after operation, while tubeless approach was preferred in 61 patients. Complications were seen in ve patients. There were not any
complications reported during the follow-up period. PAU is an effective and safe treatment modality if appropriate calyx access was performed. The possibility of renal stone treatment in the same session is an important advantage of this modality.
Keywords Ureteral stone Percutaneous antegrade
ureteroscopy Percutaneous nephrolithotomy
Introduction
The goal of treatment of ureteral stones is achieving complete stone-free status with minimal morbidity. Shockwave lithotripsy (SWL) and ureteroscopy are welldened and also popular minimally invasive treatment modalities for these stones. Despite their well-denition and popularity, there are many factors that affect the success of the treatment, such as stone location, stone size, renal or ureteral anomaly, sufcient equipment, and surgeons experience. Proximal ureteral stones treatment is still controversial because of the factors described above [15]. Besides these two methods, another treatment modality, percutaneous antegrade ureteroscopy (PAU) for ureteral stones must be kept in mind especially...