Efficacy of a percutaneous antegrade approach for the treatment of large upper ureteral stones: single-center experience

Objective: To evaluate the safety and efficacy of antegrade percutaneous nephrolithotomy (PCNL) in patients with upper ureteral calculi >= 1.5 cm. Materials and methods: From November 2006 to May 2009, 44 consecutive patients with upper ureteral stones who were treated in our center were evaluated. In all cases, stones were located in the ureteropelvic junction (UPJ) or in 5 cm of proximal ureter and had greatest diameter >= 1.5 cm. Ultrasonography (USG) and intravenous urography (IVU) were performed in all patients before surgery. After the operation, radiography, USG, and IVU were conducted. The stone-free rate, mean operative and fluoroscopy time, complications, and hospital stay were assessed. Results: Mean patient age was 41.2 years, and mean stone size was 2.3 cm (range 1.5-3.0 cm). The stonefree rate was 81.8% at the end of the procedure. When 4 patients with clinically insignificant residual fragments < 4 mm were considered, the success rate reached to 90.9%. Open surgery was performed in 2 (4.4%) patients. One (2.2%) patient underwent shock wave lithotripsy, and one (2.2%) patient was treated with ureterorenoscopy postoperatively for residual stones. A double-J stent was intraoperatively inserted into 6 (9.5%) patients because of small mucosal perforations in the pelvicaliceal system and presence of residual stones. The mean operating time, fluoroscopy time, and hospital stay were 47 min, 2.4 min, and 2.8 days, respectively. Conclusion: PCNL is a safe and effective option for upper ureteral calculi larger than 1.5 cm, providing a high stone-free rate.