Abstract

Objective: To evaluate the efficacy of anterograde percutaneous nephrolithotomy (PNL) for impacted proximal ureteral stones larger than 15 mm.

Materials and methods: We retrospectively evaluated the data of the patients who underwent PNL for impacted proximal ureteral stones between February 2007 and April 2009. Patients, who underwent PNL for a radiopaque stone larger than 15 mm localized between the upper border of the 4th lumbar vertebra and ureteropelvic junction on intravenous pyelography were included. Patients with associated renal stones and a history of previous retroperitoneal surgery were excluded. The demographics, stone-free rates, hospitalization duration, bleeding and complication rates were evaluated.

Results: Totally 39 patients underwent PNL for impacted proximal ureteral stones. Eleven patients were excluded due to previous PNL or retroperitonoscopic surgery for renal or ureteral stones. The mean age of the patients was 43.07±15.9 years and stone size was 271±85.43 mm², the male to female ratio was 16:12. Access was achieved to the upper or middle calix through an supracosal entry in 18 (%64) and subcostal entry in 10 (%36) patients. Residual-free treatment was obtained in 27 (%96.4) patients, 2 (%7.1) patients required double J stents due to ureteral perforations, and 2 (%7.1) required post-operative blood transfusion. The mean hemoglobin decrease was 1.92±1.04, hospitalisation time was 48.4±14.6 hours, the need for of analgesic use was 172.4±54.3 mg, and operation time was 78.4±19.3 min. 

Conclusion: PNL is  technique with high success rate in the presence of surgical experience and appropriate equipment for the management of impacted proximal ureteral stones.