An alternative treatment for high-burden ureteral stones: percutaneous antegrade ureteroscopy |
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Authors: | Mustafa Okan Istanbulluoglu Mehmet Resit Goren Tufan Cicek Bulent Ozturk Hakan Ozkardes |
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Institution: | (1) Konya Medical and Research Center, Baskent University, Hoca Cihan Mah. Saray Cad. No: 1, 42060 Konya, Turkey;(2) Adana Medical and Research Center, Baskent University, Dadaloglu Mh 39. Sk. No: 6 Uroloji Plk, 01250 Yuregir, Adana, Turkey;(3) Department of Urology, Baskent University School of Medicine, Fevzi Cakmak Bul 5. Sk No: 48, Ankara, Turkey |
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Abstract: | The treatment of large proximal ureteral stones continues to be controversial. We evaluated the antegrade percutaneous approaches
for the proximal ureteral stones in our clinic. In this study, 73 percutaneous antegrade ureteroscopy (PAU) operations applied
to proximal ureteral stones between February 2005 and December 2009 were included. The stones were located between ureteropelvic
junction and 4th lumbar vertebra. PAUs were applied through appropriate calyx with the patients in prone position. During
operations, amplatz dilatators were used for dilatation, and pneumatic lithotripter was used for stone fragmentation. Patients
were evaluated according to their success rate, complications, hospitalization period, and preference of drainage tube etc.
Patients’ mean age was 52.21 years, the mean stone diameter was 19.47 mm (range 15–25), the mean stone burden was 283.76 ± 49.12 mm2 (mean ± SD) (range 188.5–392.7) and the mean hospitalization time 1.69 days. Single access done in 68 patients and two accesses
were needed in 5 patients. Sixty-eight patients (93.1%) became stone-free. Nephrostomy tubes were placed in 12 patients after
operation, while tubeless approach was preferred in 61 patients. Complications were seen in five patients. There were not
any complications reported during the follow-up period. PAU is an effective and safe treatment modality if appropriate calyx
access was performed. The possibility of renal stone treatment in the same session is an important advantage of this modality. |
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