|
|
|
| Percutaneous antegrade management of large proximal ureteral stones using non-papillary puncture |
Arman Tsaturyana,*( ),Angelis Peteinarisa,Constantinos Adamoua,Konstantinos Pagonisa,Lusine Musheghyanb,Anastasios Natsosa,Theofanis Vrettosc,Evangelos Liatsikosa,d,Panagiotis Kallidonisa
|
aDepartment of Urology, University of Patras, Patras, Greece
bGerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
cDepartment of Anesthesiology and ICU, University of Patras, Patras, Greece
dDepartment of Urology, Medical University of Vienna, Vienna, Austria |
|
|
|
|
Abstract Objective: To evaluate the feasibility and the safety of medial non-papillary percutaneous nephrolithotomy (npPCNL) for the management of large proximal ureteral stones. Methods: We evaluated prospectively collected data of 37 patients with large proximal ureteral stones more than 1.5 cm in diameter treated by prone npPCNL. Depending on stone size, in-toto stone removal or lithotripsy using the Lithoclast® Trilogy (EMS Medical, Nyon, Switzerland) was performed. Perioperative parameters including operative time (from start of puncture to the skin suturing), stone extraction time (from the first insertion of the nephroscope to the extraction of all stone fragments), and the stone-free rate were evaluated. Results: Twenty- one males and 16 females underwent npPCNL for the management of large upper ureteral calculi. The median age and stone size of treated patients were 58 (interquartile range [IQR]: 51-69) years and 19.3 (IQR: 18.0-22.0) mm, respectively. The median operative time and stone extraction time were 25 (IQR: 21-29) min and 8 (IQR: 7-10) min, respectively. One case (2.7%) of postoperative bleeding and two cases (5.4%) of prolonged fever were managed conservatively. The stone-free rate at a 1-month follow-up was 94.6%. Conclusion: The npPCNL provides a straight route to the ureteropelvic junction and proximal ureter. Approaching from a dilated portion of the ureter under low irrigation pressure with larger diameter instruments results in effective and safe stone extraction within a few minutes.
|
|
Received: 05 October 2021
Available online: 20 January 2024
|
|
Corresponding Authors:
*E-mail address: tsaturyanarman@yahoo.com (A. Tsaturyan).
|
|
|
|
|
Percutaneous antegrade management of large upper ureteral stones. (A) Fluoroscopic image showing a 2.3 cm stone in the upper ureter (stone was shown with the arrow head); (B) Fluoroscopic image showing a medial non-papillary percutaneous nephrolithotomy puncture; (C) Immediate fluoroscopic image following non-papillary percutaneous nephrolithotomy showing the complete clearance of the stone; (D) Extracted stone pieces.
|
| Patient demographics and perioperative parameters | Value | | Agea, year | 58 (51-69) | | Genderb | | Male | 21 (56.8) | | Female | 16 (43.2) | | BMIa, kg/m2 | 27.4 (25.5-29.6) | | ASA scoreb | | 1 | 24 (64.9) | | 2 | 13 (35.1) | | Cumulative ureteral stone sizea, mm | 19.3 (18.0-22.0) | | Stone sideb | | Right | 22 (59.5) | | Left | 15 (40.5) | | Operative timea, min | 25 (21-29) | | Stone extraction timea, min | 8 (7-10) | | Stone extractionb | | Stone fragmentation | 30 (81.1) | | In-toto stone removal | 7 (18.9) | | Use of antegrade fURSb | 8 (21.6) | | Stone-free statusb at 1-month follow-up | 35 (94.6) | | Hemoglobin lossa, g/L | 0.97 (0.88-1.12) | | Complicationsb | | Fever (>38.0 °C) | 2 (5.4) | | Bleeding | 1 (2.7) |
|
|
Patient demographics and perioperative parameters (n=37).
|
| [1] |
Taguchi K, Hamamoto S, Osaga S, Sugino T, Unno R, Ando R, et al. Comparison of antegrade and retrograde ureterolithotripsy for proximal ureteral stones: a systematic review and meta-analysis. Transl Androl Urol 2021; 10:1179-91.
doi: 10.21037/tau-20-1296
pmid: 33850753
|
| [2] |
Zhu H, Ye X, Xiao X, Chen X, Zhang Q, Wang H. Retrograde, antegrade, and laparoscopic approaches to the management of large upper ureteral stones after shockwave lithotripsy failure: a four-year retrospective study. J Endourol 2014; 28:100-3.
doi: 10.1089/end.2013.0391
pmid: 23914784
|
| [3] |
Bozkurt IH, Yonguc T, Arslan B, Degirmenci T, Gunlusoy B, Aydogdu O, et al. Minimally invasive surgical treatment for large impacted upper ureteral stones: ureteroscopic lithotripsy or percutaneous nephrolithotomy? Can Urol Assoc J 2015; 9:E122-5. https://doi.org/10.5489/cuaj.2280.
|
| [4] |
May PC, Hsi RS, Tran H, Stoller ML, Chew BH, Chi T, et al. The morbidity of ureteral strictures in patients with prior ureteroscopic stone surgery: multi-institutional outcomes. J Endourol 2018; 32:309-14.
doi: 10.1089/end.2017.0657
pmid: 29325445
|
| [5] |
Sun X, Xia S, Lu J, Liu H, Han B, Li W. Treatment of large impacted proximal ureteral stones: randomized comparison of percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. J Endourol 2008; 22:913-7.
doi: 10.1089/end.2007.0230
pmid: 18429682
|
| [6] |
Gu XJ, Lu JL, Xu Y. Treatment of large impacted proximal ureteral stones: randomized comparison of minimally invasive percutaneous antegrade ureterolithotripsy versus retrograde ureterolithotripsy. World J Urol 2013; 31:1605-10.
doi: 10.1007/s00345-013-1026-2
|
| [7] |
Kallidonis P, Panagopoulos V, Kyriazis I, Liatsikos E. Complications of percutaneous nephrolithotomy: classification, management, and prevention. Curr Opin Urol 2016; 26:88-94.
doi: 10.1097/MOU.0000000000000232
pmid: 26555687
|
| [8] |
Goel R, Aron M, Kesarwani PK, Dogra PN, Hemal AK, Gupta NP. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries. J Endourol 2005; 19:54-7.
doi: 10.1089/end.2005.19.54
pmid: 15735384
|
| [9] |
Maheshwari PN, Oswal AT, Andankar M, Nanjappa KM, Bansal M. Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi? J Endourol 1999; 13:441-4.
doi: 10.1089/end.1999.13.441
pmid: 10479011
|
| [10] |
Kyriazis I, Kallidonis P, Vasilas M, Panagopoulos V, Kamal W, Liatsikos E. Challenging the wisdom of puncture at the calyceal fornix in percutaneous nephrolithotripsy: feasibility and safety study with 137 patients operated via a non-calyceal percutaneous track. World J Urol 2017; 35:795-801.
doi: 10.1007/s00345-016-1919-y
pmid: 27510761
|
| [11] |
Poletajew S, Zapa?a L, Piotrowicz S, Wo?yniec P, Sochaj M, Buraczy_nski P, et al. Interobserver variability of Clavien-Dindo scoring in urology. Int J Urol 2014; 21:1274-8.
doi: 10.1111/iju.12576
pmid: 25039893
|
| [12] |
Skolarikos A, Neisius S, Petrik A, Somani B, Thomas K, Gambaro G. EAU guidelines on urolithiasis. 2021. .
|
| [13] |
Kamphuis GM, Baard J, Westendarp M, de la Rosette JJ. Lessons learned from the CROES percutaneous nephrolithotomy global study. World J Urol 2015; 33:223-33.
doi: 10.1007/s00345-014-1367-5
pmid: 25100624
|
| [14] |
Basiri A, Simforoosh N, Ziaee A, Shayaninasab H, Moghaddam SM, Zare S. Retrograde, antegrade, and laparoscopic approaches for the management of large, proximal ureteral stones: a randomized clinical trial. J Endourol 2008; 22:2677-80.
doi: 10.1089/end.2008.0095
pmid: 19025388
|
| [15] |
Bhat A, Singh V, Bhat M, Khandelwal N, Bhat A. Comparison of antegrade percutaneous versus retrograde ureteroscopic lithotripsy for upper ureteric calculus for stone clearance, morbidity, and complications. Indian J Urol 2019; 35:48-53.
doi: 10.4103/iju.IJU_89_18
|
| [16] |
Topaloglu H, Karakoyunlu N, Sari S, Ozok HU, Sagnak L, Ersoy H. A comparison of antegrade percutaneous and laparoscopic approaches in the treatment of proximal ureteral stones. BioMed Res Int 2014; 2014:691946. https://doi.org/10.1155/2014/691946.
|
| [17] |
Balaji S, Ganpule A, Herrmann T, Sabnis R, Desai M. Contemporary role of multi-tract percutaneous nephrolithotomy in the treatment of complex renal calculi. Asian J Urol 2020; 7:102-9.
doi: 10.1016/j.ajur.2019.12.012
pmid: 32257802
|
| [18] |
Roberts WW, Cadeddu JA, Micali S, Kavoussi LR, Moore RG. Ureteral stricture formation after removal of impacted calculi. J Urol 1998; 159:723-6.
pmid: 9474134
|
| [19] |
Lai S, Jiao B, Diao T, Seery S, Hu M, Wang M, et al. Optimal management of large proximal ureteral stones (>10 mm): a systematic review and meta-analysis of 12 randomized controlled trials. Int J Surg 2020; 80:205-17.
doi: 10.1016/j.ijsu.2020.06.025
|
| [20] |
Sampaio FJ. Renal collecting system anatomy: its possible role in the effectiveness of renal stone treatment. Curr Opin Urol 2001; 11:359-66.
pmid: 11429494
|
| [21] |
Sampaio FJ, Aragao AH. Anatomical relationship between the intrarenal arteries and the kidney collecting system. J Urol 1990; 143:679-81.
doi: 10.1016/s0022-5347(17)40056-5
pmid: 2313791
|
| [22] |
Sampaio FJ, Passos MA. Renal arteries: anatomic study for surgical and radiological practice. Surg Radiol Anat 1992; 14:113-7.
pmid: 1641734
|
| [23] |
Kallidonis P, Kyriazis I, Kotsiris D, Koutava A, Kamal W, Liatsikos E. Papillary vs. nonpapillary puncture in percutaneous nephrolithotomy: a prospective randomized trial. J Endourol 2017; 31:S4-9. https://doi.org/10.1089/end.2016.0571.
|
| [24] |
Kallidonis P, Vagionis A, Lattarulo M, et al. Non-papillary percutaneous nephrolithotomy for treatment of staghorn stones. Minerva Urol Nephrol 2021; 73:649-54.
doi: 10.23736/S2724-6051.20.04124-7
pmid: 33256363
|
| [25] |
Kallidonis P, Vagionis A, Vrettos T, Adamou K, Pagonis K, Ntasiotis P, et al. Non papillary mini-percutaneous nephrolithotomy: early experience. World J Urol 2021; 39:1241-6.
doi: 10.1007/s00345-020-03267-z
|
| [26] |
Tahra A, Sobay R, Bindayi A, Suceken FY, Kucuk EV. Papillary vs. non-papillary access during percutaneous nephrolithotomy: retrospective, match-paired case-control study. Arch Ital Urol 2020; 92:50-2.
|
|
|
|
