Transurethral pyelocalycolithotripsy and lithoextraction - a new method of nephrolithiasis treatment

Transurethral pyelocalycolithotripsy (TUPCL) was made in 87 patients (36 males and 51 females, age 7-82 years) with solitary uroliths from April 2007 to April 2008. Of 51 pelvic and ureteropelvic nephroliths, 24 (47%) had the size of 0.5-1 cm, 22 (43%) - 1.1-2 cm, 5 (10%) - over 2 cm. Nineteen stones of the upper segment calyx were of less than 1 cm in size, 6 (32%) - 1.1-2 cm, 4 (21%) - more than 2 cm. Nine stones of the middle segment calyx were less than 1 cm in size (44%), 4 - 1 to 2 cm (44%). One patient had the stone of more than 2 cm in size. Transurethral contact pyelolithotripsy was performed in all 87 patients. The rigid ureteropyeloscope was employed in 64 (74%) cases, fibropyelocalycolithotripsy was made in 23 (26%) cases. Indications for TUPCL were failure or aftereffects of extracorporeal pyelolithotro[sy (50 cases, 65%), suspected stricture under the stone (10 cases, 12%), ligature stones (7 cases, 6%). Pelvic stones were detected at diapevtic ureteropyeloscopy in 11 (17%) patients suspected of calycopelvic papillary tumor. In 8(9%) patients nephroliths were destructed with the electromechanic probe (Medline, Russia), pneumatic contact lithotripsy was made in 22 (25%) cases (Lithoclast Master, EMS, Switzerland), Ho laser lithotripsy was made in 41 patients (WaveLight Laser Technologie AG, Germany) with a 365 mcm waveguide in 14 (17%) cases and a 600 mcm waveguide in 27 (31%) cases. Pyelocalycolithoextraction was conducted in 16 (18%) patients. Elimination of the nephroliths was achieved in 71 (81.6%) patients. This shows that TUPCL is effective and comparable by efficacy with such methods as extracorporeal lithotripsy, percutaneous nephrolitholapaxy. Rigid ureteropyeloscopy eliminated nephroliths in 53 (83%) patients, fibropyeloscopy - in 18 (77%) patients. The experience of the authors and literature data allowed them to formulate indications for TUPCL: cacycopelvic nephroliths up to 2 cm in size in their location in the pelvis and upper segment calyx and up to 1 cm in size in their location in the calyces of the middle and lower segments irrespective of renal dysfunction degree and dilation of the calycopelvic system in failure or contraindications for extracorporeal lithotripsy and percutaneous nephrolitholapaxy. In nephroliths more than 2 cm in size TUPCL can be used as a method of choice in patients with morbid obesity, anomaly of the kidneys, upper urinary tract and the spine, hemostatic disorders. In large calycopelvic stones the patients should be informed about possible staged treatment or extracorporeal lithotripsy in the postoperative period.