A.I. Sagalevich, V. V. Ozhohin, O. S. Vozianov, R. V. Sergiychuk, A.S. Frolov

Аntegrade uterolithotripsy in the treatment of proximal urolithiasis

Study purpose: to assess the possibility of antegrade percutaneous 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 calculus was 1,8±0,7 cm. At the same time, in 4 (5,3%) cases, concrements of the proximal ureter of the single kidney. 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 calix group in 24 (32,0%) cases, through the middle calix group in 39 (52,0%), and through the upper calix group in 12 (16,0%) cases.

Results. The mean time of antegrade mini percutaneous ureterolithotripsy was 58.5±15.4 min, while the stone free rate was achieved in all 75 (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 6 (8,0%) patients. The operations were ended with the installation of nephrostomy drainage in 29 (38,7%) cases, nephrostomy drainage and internal ureteral JJ stent in 35 (46,7%), and the operation was ended with a tubeless method with installation only ureteral JJ stent in 11 (14,6%) cases. Nephrostomy drainage were removed in 1-3 days. Ureteral stent removed in 14,0±7,0 days. The mean period of postoperative stay of patients in the hospital was 2,3 ± 0,8 days. It was noted that antegrade fibroureteropyeloscopy is an extremely time-consuming and cost-demanding method, which alternative may be percutaneous antegrade ureterolithotripsy with use of mini-nephroscope tubes.

Conclusions. Analysis of the treatment of proximal ureterolithiasis with the method of antegrade mini percutaneous 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 state of the stone free rate, reduction of the time of surgical treatment and hospital stay for patients with this pathology.