Impacted Upper-Ureteral Calculi &gt;1 cm: Blind Access and Totally Tubeless Percutaneous Antegrade Removal or Retrograde Approach?

Karami, Hossein; Arbab, Amir; Hosseini, Jalil; Razzaghi, Mohammad Reza; Simaei, Navid Reza

doi:10.1089/end.2006.20.616

Cited by 27 publications

(20 citation statements)

References 18 publications

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“…131 For large (>15 mm), impacted proximal ureteral stones, the stone-free rate with antegrade URS ranges between 98.5% and 100% with a low risk for complications. 130,[132][133][134][135][136] Laparoscopic, robotic or open ureterolithotomy may be considered when ureteroscopic and percutaneous procedures have failed or concomitant surgery is required. …”

Section: Antegrade Urs and Ureterolithotomymentioning

confidence: 99%

CUA Guideline: Management of ureteral calculi

Ordon

Andonian²,

Blew³

et al. 2015

CUAJ

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The focus of this guideline is the management of ureteral stones. Specifically, the topics covered include: conservative management, medical expulsive therapy, active intervention with either shockwave lithotripsy (SWL) or ureteroscopy (URS), factors affecting SWL treatment success, optimizing success, and special considerations (e.g., pregnancy, urinary diversion). By performing extensive literature reviews for each topic evaluated, we have generated an evidence-based consensus on the management of ureteral stones. The objective of this guideline is to help standardize the treatment of ureteral stones to optimize treatment outcomes.

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Section: Antegrade Urs and Ureterolithotomymentioning

confidence: 99%

CUA Guideline: Management of ureteral calculi

Ordon

Andonian²,

Blew³

et al. 2015

CUAJ

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“…For this purpose, a better outcome could be achieved by flexible ureteroscopic lithotripsy as the primary approach (8). Although the use of holmium laser or flexible ureteroscopic lithotripsy is expensive and not available in many centers especially in developing countries, the use of pneumatic lithotripsy instead of holmium laser is not appropriate due to its high probability of stone migration (9).…”

Section: Discussionmentioning

confidence: 99%

“…Altogether, holmium laser lithotripsy has good results with low complications (7), but it is expensive and unavailable in many centers. The use of pneumatic lithotripsy instead of holmium laser is not appropriate because of high possibility of stone migration (9).…”

Section: Introductionmentioning

confidence: 99%

“…The proximal dilated ureter makes most of these stones approachable with a rigid nephroscope or large-caliber flexible instruments that can fragment and remove large stone burdens efficiently (9). Traditionally, PNL has been performed in the prone position and mostly relies on fluoroscopy, exposing both the patient and the surgical team to radiation.…”

Section: Introductionmentioning

confidence: 99%

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Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone

et al. 2013

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Purpose: The aim of study was to evaluate the clinical outcomes of PNL in comparison with laparoscopic ureterolithotomy (LUL) in proximal ureteral stones larger than 1 cm. Materials and Methods: A total of 80 patients who were candidates for treatment of large ureteral stones in our urology center were enrolled in the study between September 2004 and September 2008. By using patient randomization, they were assigned into two forty-patient groups (PNL and LUL). After evaluating the patients with laboratory tests and IVP, PNL was performed under sonography guidance in the prone position or the patients were submitted to classic laparoscopic ureterolithotomy (LUL) transperitoneally. All patients underwent postoperative assessments including KUB and ultrasonography. Results: A hundred-percent success was achieved in both groups. The mean age of the patients were 39.4 (16-63) and 35.2 (18-57) years old in PNL and LUL groups, respectively. The mean stone size in PNL group was 14.2 (10-25) mm and in LUL group was 13.5 (10-28) mm. The duration of the operations were 54.35 (50-82) minutes, and 82.15 (73-180) minutes (P < 0.0001); and the average hospital stay days were 2.6 (2-5) and 3.5 (3-8) days (p = 0.011) in groups PNL and LUL, accordingly. The mean Hb decrease in PNL group was 0.9mg/dL and in LUL group was 0.4mg/dL (p = 0.001). No statistically significant differences in terms of blood transfusion, fever, ICU admission, and prolonged urinary leakage were detected in both groups. Conclusion: According to our study, percutaneous nephrolithotomy under ultrasonography guidance is comparable with the laparoscopic ureterolithotomy for the treatment of proximal ureteral stones larger than 1 cm.

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“…[2] Son yıllarda bu yöntem, büyük ve impakte üreter üst uç taşlarının tedavisinde yeniden gündeme gelmiş ve özellikle gelişmekte olan ülkelerden bu konu ile ilgili yayınlar bildirilmiştir. [6][7][8][9][10][11][12][13][14] Bu yayınların tamamında, PNL'nin büyük ve impakte üreter üst uç taşları olan olgularda etkin ve güvenilir bir şekilde yapılabileceği bildirilmektedir.…”

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Is percutaneous nephrolithotripsy still a reasonable treatment option for large upper ureteric stones?

Karademir¹,

Agaoglu²,

Dedeoglu³

et al. 2011

Turkish Journal of Urology

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Objective: To assess the efficacy of standard percutaneous nephrolithotripsy (PNL) in patients with large upper ureteric stones. Materials and methods:Between September 2009 and March 2011, 27 patients underwent standard PNL for renal stones or large upper ureteric stones. The stones were located between the ureteropelvic junction and 4th lumbar vertebra. Stone burden, success rate, operating time, access, hemoglobin drop, analgesic requirement, serum creatinine level, hospital stay, and complications were evaluated. Results:The mean stone burden was 374.1 mm 2 and the operating time was 73.3 min. The total success rate was 85.1%. Single access was used in 26 (96.2%) patients and a second access was necessary in 1 (3.8%) patient. Access was achieved to the upper, middle, and lower calix in 3 (10.7%), 21 (75%), and 4(14.3%) patients, respectively. The pre-and postoperative serum creatinine levels were 1.0±0.2 and 1.1±0.3 mg/dL, respectively (p>0.05). The mean hemoglobin decrease was 2.1 mg/dL, analgesic requirement was 230.7 mg, and hospital stay was 2.3 days. The total complication rate was 29.6%. Open surgery was required in 1 (3.7%) patient. The blood transfusion rate was 11.1%. Fever (>38.5°C), pelvic perforation, and prolonged urinary drainage were seen in 2 (7.4%), 1 (3.7%), and 1 (3.7%) patient, respectively. Auxiliary procedures were needed in 4 (14.9%) patients (extracorporeal shock wave lithotripsy in 2, and ureteroscopy and double J stenting in 1 patient each). Conclusion:PNL is still a reasonable procedure for treating large upper ureteric stones, and it can be performed safely with a favorable outcome in experienced hands. Key words:Complications; lithotripsy; percutaneous; treatment outcome; ureteral calculi. ÖZETAmaç: Büyük çaplı üst üreter taşı olan olgularda standart perkütan nefrolitotripsinin (PNL) etkinliğini değerlendirmek. Gereç ve yöntem:Eylül 2009 ile Mart 2011 tarihleri arasında 27 hastaya böbrek taşı ve/veya büyük çaplı üst üreter taşı nedeniyle standart PNL uygulandı. Taşların yerleşimi üreteropelvik bileşke ile 4. lomber vertebra arasında idi. Taş yükü, başarı oranı, operasyon süresi, giriş, hemoglobin düşüşü, analjezik gereksinimi, serum kreatinin düzeyi, hastanede kalış süresi ve komplikasyonlar değerlendirildi. Bulgular:Ortalama taş yükü 374.1 mm² ve operasyon süresi 73.3 dakika idi. Genel başarı oranı %85.1 idi. Hastaların 26'sına (%96.2) tek giriş ve 1'ine (%3.8) ise iki giriş yapıldı. Olguların 3'ünde (%10.7) üst kaliksten, 21'inde (%75) orta kaliksten, 4'ünde (%14.3) alt kaliksten giriş sağlandı. Operasyon öncesi serum kreatinin düzeyi 1.0±0.2 mg/dL ve operasyon sonrası serum kreatinin düzeyi ise 1.1±0.3 mg/dL idi (p>0.05). Ortalama hemoglobin düşüşü 2.1 mg/dL, ağrı kesici gereksinimi 230.7 mg ve hastanede kalış süresi 2.3 gün idi. Genel komplikasyon oranı %29.6 idi. Bir (%3.7) hastada açık cerrahi gereksinimi oldu. Kan transfüzyon oranı %11.1 idi. Ateş (>38.5°C), pelvik perforasyon ve uzamış idrar drenajı sırasıyla 2 (%7.4), 1 (%3.7), 1 (%3.7) olguda gözlendi. Yardımcı ...

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Impacted Upper-Ureteral Calculi >1 cm: Blind Access and Totally Tubeless Percutaneous Antegrade Removal or Retrograde Approach?

Cited by 27 publications

References 18 publications

CUA Guideline: Management of ureteral calculi

CUA Guideline: Management of ureteral calculi

Ultrasonography-guided PNL in comparison with laparoscopic ureterolithotomy in the management of large proximal ureteral stone

Is percutaneous nephrolithotripsy still a reasonable treatment option for large upper ureteric stones?

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