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Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries.

PURPOSE
To assess the safety and efficacy of antegrade percutaneous nephrolithotomy (PCNL) of large impacted proximal-ureteral calculi.


PATIENTS AND METHODS
Between July 1998 and October 2003, a total of 66 patients (43 male and 23 female; mean age 37.5 years) underwent PCNL for impacted proximal-ureteral calculi. The inclusion criteria were calculi >15 mm that were densely impacted and located between the ureteropelvic junction and the lower border of the 4th lumbar vertebra. The mean drop in hemoglobin, operating time, analgesic requirement, and hospital stay were assessed.


RESULTS
Sixty-five patients (98.5%) had complete calculus clearance in a single session through a single tract. The mean operating time and hospital stay were 47 minutes and 46 hours, respectively. The mean analgesic requirement was 65 mg of pethidine (meperidine). The mean follow-up was 14 months. There were no significant postoperative complications.


CONCLUSION
Antegrade PCNL is a safe and effective option for large, impacted proximal-ureteral calculi.