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Treatment of upper ureteral calculi with ureteroscope after anterograde low-pressure irrigation by percutaneous nephrostomy fistulation: a report of 58 cases

Objective 　To summarize the method and experiences of the treatment of upper ureteral calculi with ureteroscope after anterograde low-pressure irrigation by percutaneous nephrostomy fistulation, and to establish a minimal invasive operation mode with high clearance of stone and low urinary infection rate. Methods 　Fifty-eight patients were enrolled with upper ureteral calculi having undergone ureteroscopic pneumatic lithotripsy from Jun. 2013 to Dec. 2014 in 309 Hospital of PLA. Before surgery, all patients had undergone percutaneous nephrostomy under ultrasound scanning. Low-pressure flushing was done during operation, and ureteroscopic pneumatic lithotripsy was done during surgery. Patients in whom complete ureteroscopy could not be done were excluded. Among 58 patients, 33 were male and 25 female, the mean age was 43.5 years (22-67 years), and the average length of the ureter stones was 1.25cm (0.7-1.8cm). Results 　The ureter stones in 54 cases (93.1%) were successfully crushed during the operation; the ureter stones in 2 cases (3.4%) were wrapped by granulation tissue, and the operation was changed to laparoscopic surgery. Fragments of stones were returned to the renal pelvis during the operation in 2 patients (3.4%), and in 1 patient a D-J indwelling tube was inserted and extracorporeal shock wave for lithotripsy was done. One another patient underwent a secondary ureteroscopic lithotripsy. The mean operative time was about 47min (24-70min). No infection or secondary bleeding occurred 2 days after the removal of nephrostomy tube. The mean time of hospitalization was 4.5d (2-7d). No infection or leakage of urine occurred in all the patients. Conclusions 　Treatment of upper urinary calculi with ureteroscope after anterograde low-pressure irrigation through percutaneous nephrostomy fistula is a safe and effective operation method which is easy to perform, with low cost, minimal invasion, fewer complications, lower rate of ureter stone returning to pelvis and higher stone clearance rate. It is the preferred treatment of upper urinary calculi.
 
 DOI: 10.11855/j.issn.0577-7402.2016.02.11