OUR EXPERIENCE OF ANTEGRADE RIGID URETEROLITHOTRIPSY VIA THE UPPER CALYCEAL GROUP FOR IMPACTED CALCULI OF THE PROXIMAL URETER IN THE SUPINE POSITION: CLINICAL OBSERVATION
Background. Impacted stones in the proximal ureter are one of the most complex forms of urolithiasis, associated with a risk of ureterohydronephrotic transformation, obstructive pyelonephritis, and loss of renal functional reserve. The optimal minimally invasive approach is determined by a combination of the anatomical characteristics of the ureter, the density of the stone, and the degree of its fixation. Purpose. To evaluate the effectiveness of the authors’ technique for antegrade rigid ureterolithotripsy via a subapical upper-pole approach in the supine position. Materials and methods. We present the case of a 47-year-old female patient with an impacted stone in the upper third of the left ureter (13×9 mm, 1,100 Hounsfield units—HU), without signs of acute obstructive pyelonephritis or impaired renal nitrogen excretion. The procedure was performed in the Valdivia-Galdakao position. A subapical puncture of the upper calyx group was performed at a 40° angle to the skin surface under ultrasound guidance in color Doppler mapping (CDM) mode; the nephrostomy tract was dilated to 15/16 Ch. Antegrade rigid lithotripsy was performed using an Auriga XL 50W Ho:YAG holmium laser in fragmentation mode. A stone-free rate of 100% was achieved with a total operative time of 24 minutes and intraoperative blood loss of less than 30 mL. On the third day, the patient was discharged in satisfactory condition. Results. The postoperative period proceeded without complications. A follow-up MSCT scan 4 weeks later confirmed the absence of residual stones and dilation of the upper ureter. Conclusion. The subapical suprapolar approach in the supine position provides a direct path for the instrument to the stones in the upper third of the ureter, reduces procedure time, and allows for a high stone-free rate with minimal risk.