A good alternative treatment of large upper ureter stones: percutaneous nephroureterolithotomy

Objective: The treatment of large proximal ureteral stones still remains controversial. We reviewed the ante-grade percutaneous approaches for proximal ureteral stones in our clinic. Materials and methods: Forty-two percutaneous nephroureterolithotomy (PNUL) operations performed for proximal ureteral stones between February 2005 and January 2009 were included in the study. The stones were located between the ureteropelvic junction and 4th lumbar vertebra. PNULs were performed through the appropriate calix entry with the patients in prone position. During the operations, amplatz dilatators were used for dilatation and pneumatic lithotriptor was used for stone fragmentation. The patients were evaluated according to the success rate, complications, duration of hospitalization, duration of the operation, preference of drainage tube, etc. Results: The patients' mean age was found to be 51 years, mean stone surface area 271 mm(2) and mean hospitalization time 1.78 days. Single access was performed in 41 patients and a second access was necessary in one patient. Finally, 39 (%92.8) patients became stone free. Nephrostomy tubes were placed in 8 patients after the operation while tubeless approach was preferred in 34 patients. Complications were seen in 4 patients. No late complications were encountered during the follow-up period. Conclusion: PNUL is an effective and safe treatment modality, when accessed through the appropriate calyx. The possibility of renal stone treatment in the same session is an important advantage of this modality.