Treatment of ureterolithiasis with the use of percutaneous antegrade ureterolithotripsy

A I Sagalevich,O S Vozianov,F Z Gaysenyuk,V V Kogut,V V Ozhohin,B V Dzhuran,R V Sergiychuk

doi:10.14739/2310-1210.2018.02.124838

A I Sagalevich, O S Vozianov + Show 5 more

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https://doi.org/10.14739/2310-1210.2018.02.124838

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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.

Highlights

Today, the tactics of patients with ureteral calculi treatment is highlighted in up-to-date urological guidelines and recommendations, where a large arsenal of methods exists for this pathology treatment
When choosing the tactics for calculi of the proximal part of ureter treatment, we took into account the following criteria: the size of the calculus and the duration of its “standing” in the ureter, state of urodynamics, functional state of the kidney and anatomical state of the ureter below calculus standing
Acute purulent obstructive pyelonephritis against the background of upper or middle third of the ureter calculus; the presence of extensive ureter stricture, its high shift, an additional vessel of the kidney should be considered as contraindications to the percutaneous antegrade ureterolithotripsy (PAULT) application

Summary

Introduction

The tactics of patients with ureteral calculi treatment is highlighted in up-to-date urological guidelines and recommendations, where a large arsenal of methods exists for this pathology treatment. Over the past 15 years, retrograde ureteroscopy has been specified as a minimally invasive method for the ureteral calculi superior treatment in efficiency of ESWL [1,2]. Advances in endoscopic instruments, especially the new-generation flexible ureteroscopes and the holmium laser contact lithitriptors, have made it possible for the retrograde ureteroscopy to become the first line option for most ureteral calculi and even small intrarenal calculi. The combination of these tools allows the treatment of ureterolithiasis against a background of short-term treatment with high postoperative efficacy and low complication rates [4,5]. Large (more than 1.0 cm) or impacted calculi of the proximal ureteral parts result in decrease of the method effectiveness and increase the percentage of intraoperative complications, including proximal migration of both the calculus and its fragments into the renal cavity system [10]

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