Percutaneous Nephrolithotomy In Lateral Position For The Treatment Of Upper Ureteral Stone After Failed ESWL (53Cases Reported)

Background:Ureteral calculus is one of the common diseases in the urologic disease. It is easy to block the ureter and cause renal colic and other clinical symptoms. Clinically, calculi often blocked in the three anatomical ureteral stricture segment. Generally speaking proximal ureteral means that calculi located above L4. Because of its anatomical location, Various treatment options have been proposed for proximal ureteral stones such as SWL, URL, and percutaneous nephrolithotomy. How to effective remove the residual stones or stone fragment after ESWL failure remains challenging for urologists.Objective To evaluate the efficacy and safety of ultrasound-guided percutaneous nephrolithotomy (PCNL) in lateral position for the treatment of upper ureteral stone after failed ESWL.Methods Between June2011and March2012,53patients with upper ureteral stones after failed ESWL underwent ultrasound-guided PCNL in lateral position. Their clinical data and complications were analyzed retrospectively. The average age was46years old(range from22to76). There are more than two weeks from the beginning of the illness. All of them were finally diagnosed unilateral upper ureteral stones. Five cases occured ipsilateral kidney stones. All the patients were under the treatment of ESWL for1～3times.And all the attempt were failed. Before the treatment, they accomplish all the required examination such as urinary system plain film, intravenous urography.Stones transverse diameter measured0.6～1.2cm, longitudinal diameter was1.1～2.5cm.42cases with renal moderate hydrocephalus,11cases with severe hydrocephalus. We prepared for the surgery until urine leukocyte turn out to be (0)-(+) Conventionally,long-term oral anticoagulant drugs should be withdrew12～14d.It was 30min before we use antibiotics for prophylactic. We assess the efficacy underwent ultrasound-guided PCNL in lateral position to treat the upper ureteral stones after failed ESWL. Summarize the surgical techniques and the experience of cure the common postoperative complications.Results All operations were successfully completed. The stones in47patients were completely cleared by the first attempt. There were6patients received further auxiliary measures because of postoperative residual stones after operation. The stones in4patients were completely cleared,2patients with residual stones. The primarily stone-free rate was84.2%.The total stone free rate was96.2%. Major complications occurred in10patients after the operations. Overall,1case had significant hematuria requiring blood transfusion,9cases got fever,1case suffered from septic shock. No severe complications occurred.Conclusion In summary, the ultrasound-guided PCNL in lateral position for the treatment of upper ureteral stone after failure of ESWL has the advantage of high stone clearance rate for the first time and high safety. Concurrent disease such as kidney stones and ureteral polyps can be treated while PCNL processing. So this kind of operation is effective for the therapy to the patients with upper ureteral stones after failed ESWL.