The objective: optimization of approaches to the choice of endoscopic ureterolithorpsy method in the presence of large stones of the proximal ureter.
Materials and methods. For the period 2017–2020 y. the study included 136 patients with large stones of the proximal ureter, who were performed one of two methods of ureterolithotripsy: rULT (group I) or m-aULT (group II). In group I 73 (53,7%) patients were operated, in group II – 63 (46,3%) patients. The age of patients ranged from 18 to 81 years, the average age was 52,7 years (54±10,5). The age of patients in group II ranged from 25 to 77 (63±10,5) years; the size of a concrement from 10 to 20 (14±3,5 mm). In group I, the age of patients ranged from 18 to 91 (63,5±10 years); the size of a concrement from 7 to 20 (12±5,5 mm).
Results. The average time of m-AULT was 58,5±15,4 min, while the status of stone free was achieved in all 100% of patients. The operation ended with the installation of nephrostomy drainage in 11 (17,5%) cases, nephrostomy drainage and internal ureteral JJ-stent – in 33 (52,4%), in 19 (30,2%) cases – tubeless drainage method with the installation of ureteral stent. And the total percentage of stenting in staghorn stones of the proximal ureter, after lithotripsy and litholapaxy was 82,6% (52 patients). RULT surgery in 92% (67 patients) of cases ended with drainage of the kidney by JJ-stent, in 6 (8%) patients the operation ended without drainage.
Conclusions. Analyzing the results, it was noted that the antegrade approach is a safe and effective method of treatment for proximal ureterolithiasis in the group with large stones of the proximal ureter, where the effectiveness of RULT (SFR up to 86,3±3,9%) is significantly inferior to AULT, and minimizing the size of instruments m-aULT) reduces the number and degree of complications associated with the size of the coiled tract, while providing a high level of SFR (96,8±4,4%).
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Türk C, Knoll T, Petrik A, Sarica K, Skolarikos A, Straub M, et al. EAU Guidelines on Urolithiasis. Uroweb. 2016:82–27. Available from: http://www.uroweb.org/wp-content/uploads/EAU-Guidelines-Urolithiasis-2016-1.pdf.
Türk C, Neisius A, Petrik A, Seitz C, Skolarikos A, Thomas K. Guidelines Associates: J.F. Donaldson, T. Drake, N. Grivas, Y. Ruhayel. European Association of Urology. Guidelines on Urolithiasis. 2018 [internet publication]. http://uroweb.org/guideline/urolithiasis.
Türk C., et al. EAU Guidelines on Diagnosis and Conservative Management of Urolithiasis. Eur Urol, 2019:26.
Preminger GM, Tiselius HG, Assimos DG, et al. American Urological Association Education and Research, Inc.; European Association of Urology. 2007 Guideline for the man – agement of ureteral calculi. Eur Urol 2007;52:1610–1631.
El-Assmy A, El-Nahas AR, Youssef RF, et al. Impact of the degree of hydronephrosis on the efficacy of in situ extracorporeal shock-wave lithotripsy for proximal ureteral calculi. Scand J Urol Nephrol. 2007;41:208–13.
Scarpa RM, DeLisa A, Porru D, Usai E. Holmium: YAGlaser ureterolithotripsy. Eur Urol. 1999;35:233.
Wolf JS Jr. Treatment selection and outcomes: Ureteral calculi. Urol Clin North Am. 2007;34:421–30.
Bagley DH, Rittenberg MH. Percutaneous antegrade flexible ureteroscopy. Urology. 1986;27:331–4.
Bagley DH. Ureteroscopic stone retrieval: Rigid versus flexible endoscopes. Semin Urol. 1994;12:32–8.
Salem HK. A prospective randomized study comparingshock wave lithotripsy and semirigid ureteroscopy for the management of upper ureteral calculi. Urology. 2009;74:1216–21.
Araki M, Wong C. Direct comparison of fiberoptic anddigital ureteroscopy for upper urinary tract lithotripsy. J Urol. 2007;4(4):V1826. DOI: 10.1016/S0022-5347(18)32216-X
Gu Z, Yang Y, Ding R, Wang M, Pu J, Chen J. Comparison of Retrograde Intrarenal Surgery and Micro-Percutaneous Nephrolithotomy for Kidney Stones: A Meta-Analysis. Urol Int. 2021;105(1-2):64–70. DOI: 10.1159/000506716.
Fayad AS, Elsheikh MG, Ghoneima W. Tubeless mini-percutaneous nephrolithotomy versus retrograde intrarenal surgery for lower calyceal stones of 2 cm: A prospective randomized controlled study. Arab J Urol. 2016 Nov 29;15(1):36–41. DOI: 10.1016/j.aju.2016.10.002.
Jiao B, Luo Z, Xu X, Zhang M, Zhang G. Minimally invasive percutaneous nephrolithotomy versus retrograde intrarenal surgery in surgical management of upper urinary stones – A systematic review with meta-analysis. Int J Surg. 2019. Nov;71:1–11. DOI: 10.1016/j.ijsu.2019.09.005.
Ergin G., Köprü. B., Kırac, M. The Comparison of Flexible Ureterorenoscopy and mini-Percutaneous Nephrolithotomy in the Treatment of 10-25 mm Kidney Stones in Elderly Patients. Journal of Urological Surgery. 2021;8(1):23–8. DOI: 10.4274/jus.galenos.2020.3669.
Shao Y, Wang DW, Lu GL, Shen ZJ. Retroperitoneal laparoscopic ureterolithotomy in comparison with ureteroscopic lithotripsy in the management of impacted upper ureteral stones larger than 12 mm. World J Urol. 2015 Nov;33(11):1841–5. DOI: 10.1007/s00345-015-1545-0.
De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R, Torricelli FC, Di Palma C, Molina WR, Monga M, De Sio M. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol. 2015 Jan;67(1):125–37. DOI: 10.1016/j.eururo.2014.07.003.
Cassell A, Jalloh M, Ndoye M, Mbodji M, Gaye O, Thiam NM, Diallo A, Labou I, Niang L, Gueye S. Surgical Management of Urolithiasis of the Upper Tract – Current Trend of Endourology in Africa. Res Rep Urol. 2020 Jul 6;12:225–38. DOI: 10.2147/RRU.S257669.
Hein S, Miernik A, Wilhelm K, Schlager D, Schoeb DS, Adams F, Vach W, Schoenthaler M. Endoscopically Determined Stone Clearance Predicts Disease Recurrence Within 5 Years After Retrograde Intrarenal Surgery. J Endourol. 2016 Jun;30(6):644–9. DOI: 10.1089/end.2016.0101.
Cracco CM, Scoffone CM. ECIRS (Endoscopic Combined Intrarenal Surgery) in the Galdakao-modified supine Valdivia position: a new life for percutaneous surgery? World J Urol. 2011 Dec;29(6):821–7. DOI: 10.1007/s00345-011-0790-0.
Davis NF, Quinlan MR, Poyet C, Lawrentschuk N, Bolton DM, Webb D, Jack GS. Miniaturised percutaneous nephrolithotomy versus flexible ureteropyeloscopy: a systematic review and meta-analysis comparing clinical efficacy and safety profile. World J Urol. 2018 Jul;36(7):1127–1138. DOI: 10.1007/s00345-018-2230-x.
Jiang H, Yu Z, Chen L, Wang T, Liu Z, Liu J, Wang S, Ye Z. Minimally Invasive Percutaneous Nephrolithotomy versus Retrograde Intrarenal Surgery for Upper Urinary Stones: A Systematic Review and Meta-Analysis. Biomed Res Int. 2017;2017:2035851. DOI: 10.1155/2017/2035851.
Mager R, Balzereit C, Gust K, Hüsch T, Herrmann T, Nagele U, Haferkamp A, Schilling D. The hydrodynamic basis of the vacuum cleaner effect in continuous-flow PCNL instruments: an empiric approach and mathematical model. World J Urol. 2016 May;34(5):717–24. DOI: 10.1007/s00345-015-1682-5.
Nagele U, Nicklas A. Vacuum cleaner effect, purging effect, active and passive wash out: a new terminology in hydrodynamic stone retrival is arising – Does it affect our endourologic routine? World J Urol. 2016 Jan;34(1):143–4. DOI: 10.1007/s00345-015-1575-7.
Donaldson JF, Lardas M, Scrimgeour D, Stewart F, MacLennan S, Lam TB, McClinton S. Systematic review and meta-analysis of the clinical effectiveness of shock wave lithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy for lower-pole renal stones. Eur Urol. 2015 Apr;67(4):612–6. DOI: 10.1016/j.eururo.2014.09.054.
Ulvik Ø, Harneshaug JR, Gjengstø P. Ureteral Strictures Following Ureteroscopic Stone Treatment. J Endourol. 2020 Oct 21. DOI: 10.1089/end.2020.0421.
May PC, Hsi RS, Tran H, Stoller ML, Chew BH, Chi T, Usawachintachit M, Duty BD, Gore JL, Harper JD. The Morbidity of Ureteral Strictures in Patients with Prior Ureteroscopic Stone Surgery: Multi-Institutional Outcomes. J Endourol. 2018 Apr;32(4):309–14. DOI: 10.1089/end.2017.0657.