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Abstract

Abstract Title

Antegrade Approach for Impacted Proximal Ureteral Calculi

Presentation Type

Video Abstract

Manuscript Type

Case Study

Abstract Category *

Endourology: Urolithiasis

Author's Information

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Co-author 1

Freddie Sy docurosy@gmail.com Bicol Medical Center Department of Surgery Naga City Philippines *

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Abstract Content

Introduction

Long standing impacted ureteral calculi post a challenge in ureteroscopy due to peri ureteral edema tortuosity and narrow working space. There is a risk of ureteral injury and perforation. We will be presenting our technique on the antegrade approach for proximal ureteral calculi as an option.

Materials and Methods

This is a case of a 57 years old male presenting with recurrent urinary tract infection due to an impacted left ureteral calculus measuring 1.4 cm causing moderate hydronephrosis.On retrograde pyelography we were not able to bypass the calculi nor delineate the collecting system. An Ultrasound guided supine Percutaneous Nephrostolithotomy was performed with serial fluoroscopic guided dilatation. Using a French 16 amplazt sheath with French 12 nephroscope. The amplazt was easily torque to the proximal ureter and impacted calculi was fragmented with holmium laser 600 microns on dusting mode. Fragmentation technique will be demonstrated. Calculi were evacuated using the vacuum cleaner effect. Post operative course was unremarkable patient was discharging d after 48 hours.

Results

Complete stone fragmentation was achieved, operative time of 60 minutes. The open-ended stent was removed after 48 hours and nephrostomy tube on the 7th post op day.

Conclusions

Antegrade approach for impacted ureteral calculi is a good alternative in cases of failure of retrograde approach.

Keywords

Antegrade approach , Impacted Calculi,Proximal Ureteral calculi

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