Modern Methods of Treatment for Proximal Ureterolithiasis


Vladyslav Ozhogin


Urolithiasis is a disease characterized by the formation of stones in the urinary tract. According to statistics, SCC causes about 30% of hospitalizations in the urology department.

Treatment of SCC is divided into conservative and operative. The choice of method depends on age, clinical course of the disease, general condition of the patient, anatomical and functional condition of the kidneys and the size of the localization of the calculus. Methods of treatment of SC have changed significantly in recent years.

Due to the technical achievements of the method of open ureterolithotomy, which was once the standard method of treatment of so-called «complicated» concretions of the ureter, evolved into a laparoscopic ureterolithotomy, and with the advent of ultrasonic and laser lithotriptors – began the newest era of minimally invasive urology– extracorporeal shock-wave lithotripsy and endourology: antegrade percutaneous ureterolithotripsy, retrograde ureteroscopic lithotripsy and flexible retrograde uretherolithotripsy (FURS).

The purpose of the work – on the basis of scientific literature to assess the effectiveness, safety and profitability of modern methods of surgical treatment for proximal ureterolithiasis. During the scientific research, attention was paid to the following parameters: stone free rate (SFR), postoperative pain level, need for painkillers, number of postoperative bed-days, presence of postoperative fever, hemoglobin level, need for blood transfusion, and on the economic component during the implementation of a technique.

The principles of treatment of patients with large proximal ureterolithiasis are described in the clinical guidelines of the European and American Associations of Urologists. However, for example, which of the 3 proposed methods of treatment of large proximal ureterolithiasis to choose – there is no consensus from the world urological community.

Percutaneous antegrade ureterolithotripsy is the preferred method of choice in patients with large proximal ureteral stones that cannot be removed by contact or extracorporeal ureterolithotripsy, characterized by a high level of absence of stones and minimal complications, optimal post operative and high indicators of economic attractiveness of this technique.


How to Cite
Ozhogin, V. (2021). Modern Methods of Treatment for Proximal Ureterolithiasis. Health of Man, (3), 95–101.
Author Biography

Vladyslav Ozhogin, Shupyk National Healthcare University of Ukraine

Vladyslav V. Ozhogin,

Department of Urology


Wagner CA. Etiopathogenic factors of urolithiasis. Arch Esp Urol. 2021 Jan;74(1):16-23. English, Spanish.

Drake R.L., Vogl A.W., Mitchell A.W.M. Gray’s Anatomy for Students 3rd Edition. Elsevier Health Sciences, 2015; 1161-379 р.

Bourdoumis A, Papatsoris A, Calleary JG, Surange R, Skrepetis K, Buchholz N, Sarica K. The evolution of urolithiasis assessment and management in the new millennium. Panminerva Med. 2016 Sep;58(3):222-36. Epub 2016 Apr 13.

Tiselius HG, Ackermann D, Alken P, Buck C, Conort P, Gallucci M; Working Party on Lithiasis, European Association of Urology. Guidelines on urolithiasis. Eur Urol. 2001 Oct;40(4):362-71. DOI: 10.1159/000049803.

Alelign T, Petros B. Kidney Stone Disease: An Update on Current Concepts. Adv Urol. 2018 Feb 4;2018:3068365. DOI: 10.1155/2018/3068365.

Morgentaler A, Bridge SS, Dretler SP. Management of the impacted ureteral calculus. J Urol. 1990 Feb;143(2):263-6. DOI: 10.1016/s0022-5347(17)39928-7.

Mugiya S, Ito T, Maruyama S, Hadano S, Nagae H. Endoscopic features of impacted ureteral stones. J Urol. 2004 Jan;171(1):89-91. DOI: 10.1097/01.ju.0000100960.08768.81.

Elbaset M, Edwan M, Abouelkheir R, Ashour R, Ramez M, Abdelhamid A, Osman Y. Predictors for Retrograde Ureteral Stenting Failure as an Initial Drainage Method for Emergent Complicated Acute Calculus Obstructive Uropathy. Soc Int Urol J.2021;2(4):229–238. DOI: 10.48083/OZUL6913.

Assimos D, Krambeck A, Miller NL, Monga M, Murad MH, Nelson CP, Pace KT, Pais VM Jr, Pearle MS, Preminger GM, Razvi H, Shah O, Matlaga BR. Surgical Management of Stones: American Urological Association /Endourological Society Guideline, PART I. J Urol. 2016 Oct;196(4):1153-60. DOI: 10.1016/j.juro.2016.05.090. Epub 2016 May 27.

Skolarikos A. Medical treatment of urinary stones. Curr Opin Urol. 2018 Sep;28(5):403-407. DOI: 10.1097/MOU.0000000000000523.

Sagalevich A, Vozianov O, Sergiychuk R, Dzhuran B, Kogut V, Gaysenyuk F, Ozhohin V, Korytskyi A. Rational choice of a minimally invasive method of treatment in uncomplicated nephrolithiasis with kidney calculi from 1.0 to 2.5 cm. Zaporozhye medical journal 2018; 20(1):58-62. DOI: 10.14739/2310-1210.2018.1.121993.

Taguchi K, Cho SY, Ng AC, Usawachintachit M, Tan YK, Deng YL, Shen CH, Gyawali P, Alenezi H, Basiri A, Bou S, Djojodemedjo T, Sarica K, Shi L, Singam P, Singh SK, Yasui T. The Urological Association of Asia clinical guideline for urinary stone disease. Int J Urol. 2019 Jul;26(7):688-709. DOI: 10.1111/iju.13957. Epub 2019 Apr 24.

Ordon M, Urbach D, Mamdani M, Saskin R, D’A Honey RJ, Pace KT. The surgical management of kidney stone disease: a population based time series analysis. J Urol. 2014 Nov;192(5):1450-6. DOI: 10.1016/j.juro.2014.05.095. Epub 2014 May 24.

Türk, C., Neisius, A., Petřík, A., Seitz, C., Thomas, K. & Skolarikos, A. EAU Guidelines on Urolithiasis 2021. European Association of Urology Guidelines. 2021 Edition. presented at the EAU Annual Congress Amsterdam 2021. The European Association of Urology Guidelines Office; 2021

Sagalevich A, Vozianov O., Ozhohin V, Dzhuran B, Kogut V, Gaysenyuk F, Sergiychuk R. Treatment of ureterolithiasis with the use of percutaneous antegrade ureterolithotripsy. Zaporozhye medical journal 2018; 20(2), 162–6. DOI: 10.14739/2310-1210. 2018.2.124838.

Yanaral F, Ozgor F, Kucuktopcu O, Sarilar O, Ayranci A, Savun M, Yuksel B, Binbay M. Comparison of Flexible Ureterorenoscopy and Mini Percutaneous Nephrolithotomy in the Management of Multiple Renal Calculi in 10-30 mm Size. Urol J. 2019 Aug 18;16(4):326-330. DOI: 10.22037/uj.v0i0.3310. PMID: 30334245.

Salem HK. A prospective randomized study comparing shock wave lithotripsy and semirigid ureteroscopy for the management of proximal ureteral calculi. Urology. 2009 Dec;74(6):1216-21. DOI: 10.1016/j.urology.2009.06.076. Epub 2009 Oct 7.

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. Epub 2020 Nov 23.

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. Epub 2019 Sep 12.

Yencilek F, Sarica K, Erturhan S, Yagci F, Erbagci A. Treatment of ureteral calculi with semirigid ureteroscopy: where should we stop? Urol Int. 2010;84(3):260-4. DOI: 10.1159/000288225. Epub 2010 Apr 13.

Bryniarski P, Paradysz A, Zyczkowski M, Kupilas A, Nowakowski K, Bogacki R. A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter. J Endourol. 2012 Jan;26(1):52-7. DOI: 10.1089/end.2011.0235. Epub 2011 Oct 17.

Van Compernolle D, Veys R, Elshout PJ, Beysens M, Van Haute C, De Groote L, Tailly T. Reusable, Single-Use, or Both: A Cost Efficiency Analysis of Flexible Ureterorenoscopes After 983 Cases. J Endourol. 2021 May 19. DOI: 10.1089/end.2021.0006. Epub ahead of print.

Zhu M, Wang X, Shi Z, Ding M, Fan D, Wang X, Jiang R. Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta-analysis. Exp Ther Med. 2019 Aug;18(2):1366-1374. DOI: 10.3892/etm.2019.7710. Epub 2019 Jun 25.

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):125-137. DOI: 10.1016/j.eururo.2014.07.003. Epub 2014 Jul 23. Erratum in: Eur Urol. 2016 Apr;69(4):e85.

Monga M, Oglevie S. Minipercutaneous nephrolithotomy. J Endourol. 2000 Jun;14(5):419-21. DOI: 10.1089/end.2000.14.419.

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. Epub 2017 May 3.

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. Epub 2015 May 23.

Sahalevych A, Sergiychuk R, Ozhohin V, Vozianov O, Khrapchuk A, Dubovyi Ya, Frolov O. Mini-percutaneous nephroli thotomy in surgery of nephrolithiasis. Ukr J Nephr Dial. 2021;3(71):44-52. DOI: 10.31450/ukrjnd.3(71).2021.06

Donaldson JF, Lardas M, Scrimgeour D, Stewart F, MacLennan S, Lam TB, Mc-Clinton S. Systematic review and metaanalysis 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. Epub 2014 Oct 23.

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 Jul-Aug;13(6):441-4. DOI: 10.1089/end.1999.13.441.

Zhang H, Hong TY, Li G, Jiang N, Hu C, Cui X, Chu C, Zhao JL. Comparison of the Efficacy of Ultra-Mini PCNL, Flexible Ureteroscopy, and Shock Wave Lithotripsy on the Treatment of 1-2 cm Lower Pole Renal Calculi. Urol Int. 2019;102(2):153-9. DOI: 10.1159/000493508. Epub 2018 Oct 23.

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):1127-38. DOI: 10.1007/s00345-018-2230-x. Epub 2018 Feb 16.

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. Epub 2016 Apr 22.

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. Epub 2014 Jul 23. Erratum in: Eur Urol. 2016 Apr;69(4):e85.

Ulvik Ø, Harneshaug JR, Gjengstø P. Ureteral Strictures Following Ureteroscopic Stone Treatment. J Endourol. 2021 Jul;35(7):985-990. DOI: 10.1089/end.2020.0421. Epub 2020 Oct 21.

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.

Stern JM, Yiee J, Park S. Safety and efficacy of ureteral access sheaths. J Endourol. 2007 Feb;21(2):119-23. DOI: 10.1089/end.2007.9997.

Zhang L., Fei X., Song Y. Retrograde intrarenal surgery or percutaneous nephrolithotomy in the treatment of impacted proximal ureteric calculi. Research Square 2021.

Lahme S. Miniaturisation of PCNL. Urolithiasis. 2018 Feb;46(1):99-106. doi: 10.1007/s00240-017-1029-3. Epub 2017 Dec 14.

Vozianov S, Sahalevych A, Boiko A, Haiseniuk F, Kohut V, Dzhuran B, Sosnin M. A modern view on tubeless percutaneous nephrolithotomy. Zaporozhye medical journal 2021; 23 (4), 575-82. DOI: 10.14739/2310-1210.2021.4.226895

Q. Ding, Weifeng Wang, W. Shao, X. Chen. Local anesthesia effect of minimally invasive percutaneous nephrolithotomy on systemic inflammatory response and renal function damage. Int J Clin Exp Med 2017;10(2):3747-51.

Osther PJS. Risks of flexible ureterorenoscopy: pathophysiology and prevention. Urolithiasis. 2018 Feb;46(1):59-67. DOI: 10.1007/s00240-017-1018-6. Epub 2017 Nov 18.

Mufti Mahmood Ahmed, Bilal Yousuf Mir, Zaffer Saleem Khanday, Syed Javid Farooq Qadri and Fayaz Ahmad Najar. (2018); A comparative study of mini-percutaneous nephrolithotripsy and ureteroscopic pneumatic lithotripsy in the treatment of large impacted upper ureteric stones. Int. J. of Adv. Res. 6 (May)

Najar FA et al. (2018) Safety and efficacy of Mini-Percutaneous Nephrolithotomy in the treatment of large impacted Proximal Ureteral Stones. J Surg Surgical Res 4(2): 15-8.

Sugihara T, Yasunaga H, Horiguchi H, Fujimura T, Nishimatsu H, Kume H, Ohe K, Matsuda S, Fushimi K, Homma Y. Longer operative time is associated with higher risk of severe complications after percutaneous nephrolithotomy: analysis of 1511 cases from a Japanese nationwide database. Int J Urol. 2013 Dec;20(12):1193-8. DOI: 10.1111/iju.12157. Epub 2013 Apr 21.

Liu X, Huang G, Zhong R, Hu S, Deng R. Comparison of Percutaneous Nephrolithotomy Under Regional versus General Anesthesia: A Meta-Analysis of Randomized Controlled Trials. Urol Int. 2018;101(2):132-142. DOI: 10.1159/000491021. Epub 2018 Jul 20.