Purpose: To share our multicenter experience using a safe and effective method for treating large proximal ureteral calculus by simultaneous supine percutaneous nephrolithotomy (sPCNL) and retrograde ureterolithotripsy (URSL) in the Galdakao-modified supine Valdivia position.
Materials and Methods: Between December 2014 and August 2017, all patients with large proximal ureteral stones (> 15 mm) who underwent simultaneous sPCNL and retrograde URSL at three medical centers were retrospectively reported. The ureter stone was pushed back (retrograde) with the ureteroscope and was retrieved using forceps with a nephroscope through an Amplatz sheath. Surgical methods and outcomes were described to improve our experience and management of large proximal ureteral calculi.
Results: A total of 31 patients underwent simultaneous sPCNL and retrograde URSL. The mean patient age, stone size, operating time, and postoperative hospital stay were 57 years (range, 32–74 years), 20.1 mm (range, 15.0–37.9 mm), 81 minutes (range, 30–150), and 3.2 days (range, 2–7 days), respectively. There were 10 modified Clavien grade I and five grade II complications. No blood transfusions were necessary in this series. All patients were treated with double-J stents without a nephrostomy tube. Only one patient did not achieve stone-free status because of the strict stone impaction into the ureteral wall. This patient received auxiliary URSL after two months. Thereafter, the overall stone-clearance rate at three months was 100%.
Conclusion: Our preliminary data showed that this modified method is safe and effective for treating large proximal ureteral stones.
Dean A, Amy K, Nicole LM, et al. Surgical management of stones: American Urological Association / Endourological Society Guideline. Available from: http://www.auanet.org/education/guidelines/surgical-management-of-stones. Accessed December 15, 2016.
Preminger GM, Tiselius HG, Assimos DG, et al. EAU/AUA Nephrolithiasis Guideline Panel. J Urol. 2007;178:2418-2434.
Türk C, Knoll T, Petrik A, et al. Guidelines on urolithiasis. EAU. 2016. Available at: http://uroweb.org/guideline/urolithiasis/. Accessed December 15, 2016.
Kallidonis P, Panagopoulos V, Kyriazis I, Liatsikos E. Complications of percutaneous nephrolithotomy: classification, management, and prevention. Curr Opin Urol. 2016;26:88-94.
Tiselius H-G, Andersson A. Stone burden in an average Swedish population of stone formers requiring active stone removal: how can the stone size be estimated in the clinical routine? Eur Urol 2003;43:275-81.
Scoffone CM, Cracco CM, Cossu M, Grande S, Poggio M, Scarpa RM. Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 2008;54:1393-403.
Tefekli A, Ali Karadag M, Tepeler K, et al. Classification of percutaneous nephrolithotomy complications using the modified Clavien grading system: looking for a standard. Eur Urol 2008;53:184-90.
Srisubat A, Potisat S, Lojanapiwat B, Setthawong V, Laopaiboon M. Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones. Cochrane Database Syst Rev 2009, CD007044
White W, Klein F. Five-year clinical experience with the Dornier Delta lithotriptor. Urology. 2006;68:28-32.
Chow GK, Patterson DE, Blute ML, Segura JW. Ureteroscopy: effect of technology and technique on clinical practice. J Urol. 2003;170:99-102.
Bozkurt IH, Yonguc T, Arslan B, et al. Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy? Can Urol Assoc J. 2015;9:E122-5.
Wang Q, Guo J, Hu H, et al. Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis. PLoS One. 2017;12:e0171478.
Seitz C, Desai M, Häcker A, et al. Incidence, prevention, and management of complications following percutaneous nephrolitholapaxy. Eur Urol. 2012;61:146-158
Ritter M, Krombach P, Michel MS. Percutaneous stone removal. Eur Urol Suppl 2011;10:433-9.
Kumar A, Nanda B, Kumar N, Kumar R, Vasudeva P, Mohanty NK. A prospective randomized comparison between shockwave lithotripsy and semirigid ureteroscopy for upper ureteral stones >2 cm: a single center experience. J Endourol. 2015;29:47-51.
Kadyan B, Sabale V, Mane D, et al. Large proximal ureteral stones: Ideal treatment modality? Urol Ann. 2016;8:189-92.
Torricelli FC, Monga M, Marchini GS, Srougi M, Nahas WC, Mazzucchi E. Semi-rigid ureteroscopic lithotripsy versus laparoscopic ureterolithotomy for large upper ureteral stones: a meta - analysis of randomized controlled trials. Int Braz J Urol. 2016;42:645-54.
Liu Y, Zhou Z, Xia A, Dai H, Guo L, Zheng J. Clinical observation of different minimally invasive surgeries for the treatment of impacted upper ureteral calculi. Pak J Med Sci. 2013;29:1358-62.
DeRosette JJ, Tsakiris P, Ferrandino MN, et al. Beyond prone position in percutaneous nephrolithotomy: a comprehensive review. Eur Urol. 2008;54:1262-9.
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;29:821-7.