Original Articles
Migrated upper ureteric stone during laparoscopic ureterolithotomy (LU); Does percutaneous nephrolithotomy (PNL) remain the salvage procedure of choice? | |
Dr. Arvind Kumar, Dr. Praveen Lakhera, Dr. Prashant Patel, Dr. APS Thakur, Dr. Fanindra S Solanki. | |
Objective- To review our experience of percutaneous nephrolithotomy (PNL) as salvage procedure for stone removal in patients with intraoperative migrated upper ureteral stones in pelvi-calyceal system (PCS) during laparoscopic ureterolithotomy(LU). Methods- Between 2015 and 2022, a total of 95 patients were subjected to either transperitoneal (TPLU) or retroperitoneal LU (RPLU). TPLU was done in 28 and RPLU was done in 67 cases respectively. In 18 cases there was intra operative up migration of stone in PCS. Of these 18 patients, open surgery was done in 6 cases (3 in each retroperitoneal and transperitoneal group) and PNL was done in 12 cases of retroperitoneal ureterolithotomy group. Stone clearance was confirmed intraoperatively by fluoroscopy and by x ray KUB in post operative period. Results- Mean age of patients was 42.86±9.15 yrs. 10 were males and 8 were females. Mean stone size was 1.64±0.34 cm. Migrated stone was present in pelvis (6), middle calyx (10) and inferior calyx (2). Open surgery was done in 6 cases with complete stone clearance. During PNL, mid posterior calyceal puncture was done in 8 and superior calyceal puncture was done in 4 renal units. Complete stone clearance was achieved in all patients in same sitting. 2 patients of PNL group and 3 of open surgery group had postoperative fever which was conservatively managed. 3 patients in open surgery group had ileus which was managed conservatively. Conclusion- PNL is a viable and highly successful salvage procedure in patients with up migrated upper ureteric stones during laparoscopic ureterolithotomy. |
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