Non-Papillary Access for the Percutaneous Antegrade Treatment of Renal and Ureteral Stones.

OBJECTIVE

To evaluate the feasibility and success of medial non-papillary percutaneous access for the antegrade treatment of different locations of ureteral stones, with and without concomitant renal stones.

METHODS

We performed an analysis of prospectively collected data of 72 patients, being subjected to percutaneous antegrade ureterolithotripsy. Stones located anywhere in the ureter with or without concomitant renal stones were included. A 12Fr, 22Fr, or 30Fr percutaneous tract dilation was performed based on the size of the stone pelvicalyceal system. Perioperative and demographic parameters were gathered and evaluated. The Lithoclast Trilogy (EMS Medical, Nyon, Switzerland) High-power holmium laser devices Cyber Ho 150 (Quanta System, Samarate, Italy) or MOSES Pulse 120H (Lumenis Ltd, Yokneam, Israel) were used for lithotripsy.

RESULTS

The average age and cumulative stone size of the patients were 57.9 ± 27.1 years and 24.2 ± 5.4 mm, respectively. The mean manipulation time was 36.9 ± 14.8 minutes. The mean hospitalization time was 2.5 ± 0.5 days and the average hemoglobin loss was 1.02 ± 0.18 gr/dL. The stone-free rate after percutaneous antegrade ureterolithotripsy was 95.8 % (69 patients), while the overall complications rate was 5.6 %, with 3 cases of fever and one case of prolonged hematuria that were treated conservatively.

CONCLUSION

Non-papillary percutaneous antegrade ureterolithotripsy is a safe and reliable technique for the treatment of patients with ureteral stones, with or without the co-existence of renal stones. A high stone-free rate of 95.8% was reported at 1-month after the surgery carrying a weighted risk of developing postoperative complications.