Percutaneous Treatment of Ureteral Stones

Percutaneous antegrade ureteroscopy is an effective treatment modality for ureteral stones, particularly when shockwave lithotripsy and retrograde ureteroscopy are presumed to have low success rates or to present increased complications. Indications for an antegrade approach include the presence of large stones with proximal hydroureteronephrosis, concomitant ureteral and renal stones, stone impaction, distal ureteric stricture, urinary diversion, nonrefluxing ureteroneocystostomy, and special anatomic considerations. Preoperative evaluation focuses on burden of stone disease, anatomy of the upper tract, and general patient status. Entrance through an upper or mid-upper calyx is preferred and a flexible nephroscope or ureteroscope is used to access the ureter and stone. The stone can be fragmented or extracted intact with the aid of a basket, as in most instances the upper ureter is fairly dilated. Studies show single-procedure stone-free rates to range from 86% to 100%. Follow-up is necessary for early detection of potential postoperative ureteral strictures.