• Assistive internal fluid circulatory device
• Stone free rate
• Stone migration
• Ureteral stones
• Ureteroscopic lithotripsy

• Humans
• Male
• Female
• Ureteral Calculi/therapy
• Ureteral Calculi/surgery
• Ureteroscopy/instrumentation
• Ureteroscopy/methods
• Lithotripsy/instrumentation
• Lithotripsy/methods
• Lithotripsy/adverse effects
• Prospective Studies
• Middle Aged
• Adult
• Operative Time
• Equipment Design
• Treatment Outcome
• Aged

• A2022248 Medical Scientific Research Foundation of Guangdong Province, China

• Meta-analysis
• Suction
• Ureteroscopy
• Urinary calculi

• Humans
• Kidney Calculi/surgery
• Suction/methods
• Operative Time
• Length of Stay
• Vacuum

• Laser
• percutaneous nephrolithotomy
• retrograde intrarenal surgery

• 365 µm fibers
• Flexible ureteroscopic lithotripsy
• Ho:YAG laser
• Infection
• Safety

• Humans
• Lasers, Solid-State/therapeutic use
• Lasers, Solid-State/adverse effects
• Male
• Female
• Lithotripsy, Laser/methods
• Lithotripsy, Laser/adverse effects
• Lithotripsy, Laser/instrumentation
• Middle Aged
• Prospective Studies
• Ureteroscopy/adverse effects
• Ureteroscopy/methods
• Ureteroscopy/instrumentation
• Follow-Up Studies
• Adult
• Aged
• C-Reactive Protein/analysis
• Treatment Outcome
• Retrospective Studies
• Leukocyte Count
• Risk Factors
• Ureteral Calculi/surgery
• Ureteral Calculi/therapy

• 82170769 National Natural Science Foundation of China
• 81870512 National Natural Science Foundation of China

• antegrade
• laser treatment
• retrograde
• ureteric stones
• ureteroscopy

• Antegrade percutaneous nephrolithotomy
• Large ureteral stone
• Non-papillary puncture
• Prone percutaneous nephrolithotomy
• Proximal ureteral stone

• flexible ureteroscopic lithotripsy
• proximal ureteral stones
• tubeless percutaneous nephrolithotomy

• Deviation
• Impaction
• Medial
• Stone
• Ureter

• Humans
• Ureter/diagnostic imaging
• Pilot Projects
• Ureteral Calculi/complications
• Ureteral Calculi/diagnostic imaging
• Ureteral Calculi/therapy
• Urinary Calculi
• Ureteroscopy
• Treatment Outcome

• Antegrade ureteroscopy
• Reterograde intrarenal surgery
• Upper ureteric stones

• Humans
• Ureteroscopy/adverse effects
• Urinary Calculi/surgery
• Ureteral Calculi/surgery
• Ureteral Calculi/complications
• Kidney
• Kidney Calices
• Kidney Calculi/complications
• Treatment Outcome

• Benha University

• Complications
• RIRS
• Stone free rate
• Urinary tract stones
• Urolithiasis
• mPCNL

• Humans
• Nephrolithotomy, Percutaneous/adverse effects
• Kidney Calculi/surgery
• Treatment Outcome
• Randomized Controlled Trials as Topic
• Urinary Calculi/surgery
• Urinary Tract
• Nephrostomy, Percutaneous

• kidney lithiasis
• mini-perc
• minimally invasive nephrolithotomy

• ECIRS
• ambulatory
• minimally invasive

• dusting
• high-power laser
• laser lithotripsy
• retrograde intrarenal surgery
• stone self-popping

• Holmium
• Humans
• Kidney Calculi/surgery
• Lasers, Solid-State/therapeutic use
• Lithotripsy
• Lithotripsy, Laser/methods
• Treatment Outcome

• Flexible ureteroscopy
• Kidney stones
• Miniperc
• Stone free
• Urolithiasis

To compare the safety and efficacy of various surgical modalities to manage large (> 1 cm) upper ureter stones. Systematic literature search was conducted to include all randomized studies comparing various treatment options for large (> 1 cm) upper ureteric stones. This review included 13 randomized studies with 1871 patients. Laparoscopic ureterolithotomy (LUL) and percutaneous nephrolithotomy (PNL) were superior to ureteroscopy (URS) and shockwave lithotripsy (SWL) for stone-free rates and need for auxiliary treatments. LUL and PNL were equally effective for stone-free rates and the need for auxiliary treatments. According to SUCRA values for stone-free rates and the need for auxiliary treatments, LUL was the best, followed by PNL. For the duration of surgery, there was no significant difference among all the techniques on network analyses, and SWL was the best according to SUCRA values. Length of hospital stay was significantly shorter for URS than LUL and PNL from network analysis, but there was no significant difference for the rest of the comparisons. Overall complications were similar in all the groups. According to the CINeMa approach, the confidence rating ranged from “very low” to “moderate” for various comparisons. LUL followed by PNL is the most efficacious treatment modality for upper ureteric stones compared to SWL and URS in terms of stone-free rates. However, due to the poor quality of included studies, further high-quality randomized studies are needed.

The landscape of managing ureteric stones has evolved over the last few decades and several treatment options exist depending on the stone size, location, and other patient and stone factors. While open surgery is now rarely performed, the use of medical expulsive therapy (MET) has been controversial and perhaps only recommended for large distal ureteric stones. The mainstay treatment balances between shockwave lithotripsy (SWL) and ureteroscopy (URS), with the latter usually recommended for larger stones. While the principles of ureteric stone management have remained largely unchanged, the modern era has generated new methods and means to deliver it. Advancements have occurred in all domains of endourology to try and refine treatment and balance it with cost, patient choice and quality of life. Dissemination of technologies and demonstration of their efficacy and safety will eventually result in new recommendations among international guidelines and evolution of new gold standards.

• PCNL
• RIRS
• SWL
• kidney calculi
• percutaneous nephrolithotomy
• ureteric stone
• ureteroscopy

X-ray-free endoscopic combined intra renal surgery (ECIRS) is a feasible alternative to avoid radiation exposure to both surgical teams and patients, but has not been reported prior. The aim of this report is to present our first-hand experience of performing X-ray-free ECIRS for complex ureteral stone. A 57-year-old female presented with right flank pain, fever, dysuria, and leukocytosis. The computed tomography scan showed right impacted proximal ureteral stone sized 33 ´17 mm and grade IV hydronephrosis. Percutaneous nephrostomy was performed immediately. With improvement of clinical symptoms two days after nephrostomy, X-ray-free ECIRS was performed. The patient was placed in a Galdakao-modified supine position. During ureteroscopy (URS), there was noted right ureteral stenosis in the distal part of the stone, which could be passed. However, the stone was impacted and the semi-rigid URS was not able to push it. Therefore, antegrade approach with percutaneous nephrolithotomy was performed. Previous nephrostomy tract was used as percutaneous access. Tract dilatation was performed under direct visualization from the URS. The 28 Fr rigid nephroscope was used during the ECIRS procedure. The stone was fragmented using shock-pulse lithotripters. There was no residual stone or infundibular laceration after the procedure. A 6 Fr double J stent was inserted retrogradely due to ureteral stenosis. There was no complication during and after the procedure. The patient was discharged on post-operative day three. X-ray free ECIRS for complex proximal ureteral stone was possible and showed good results.

• ECIRS
• modified procedure
• supine position
• ureterolithiasis

• Ureteroscopic lithotripsy
• antegrade ureteroscopy
• impacted stones
• percutaneous nephrolithotomy
• proximal ureteral stones

Objectives: To study a modification to the conventional retrograde ureteroscopic approach for treating proximal ureteric stones of 1–2 cm; we intentionally push the stone from the proximal ureter into a favourable calyx then the flexible ureteroscope is used to fragment the trapped stone using laser lithotripsy (‘boxing in the corner’).

Patients and methods: The study was conducted in a randomised prospective manner and included 100 patients who presented with a single proximal ureteric stone of 1–2 cm. We randomised the patients into two equal groups: Group A (50 patients) underwent the conventional retrograde technique (CRT) and Group B (50 patients) underwent the modified retrograde technique (MRT) with the primary intention of relocating the stone into a favourable calyx. Intended relocation of the proximal ureteric stone in the MRT group was achieved in a stepwise manner. All intraoperative parameters and postoperative outcomes were recorded and compared between the two groups.

Results: There was no statistical significant difference in terms of the patients’ demographics and stone criteria between the two groups. The stone-free rate (SFR) was significantly higher in Group B (92%) compared to Group A (78%) (P = 0.049). Fluoroscopy time was significantly longer in Group B (P < 0.001), while operative time, lithotripsy time and hospital stay were comparable. There was no difference between the groups regarding complications.

Conclusion: The MRT was found to be safe and more effective than the CRT for treating proximal ureteric stones of 1–2 cm, with a significantly higher SFR.

Abbreviations CONSORT: Consolidated Standards of Reporting Trials; ESWL: extracorporeal shockwave lithotripsy; fURS: flexible ureteroscope; NCCT: non-contrast CT; SFR: stone-free rate; YAG: yttrium-aluminium-garnet

• Lithotripsy
• laser
• proximal ureter
• stones
• ureteroscopy

The aim of the study is to demonstrate the ease and success of in situ management of large upper ureteric stones with mini percutaneous nephrolithotomy (PCNL).

This was a prospective observational study conducted in the Department of Urology between January 2018 and June 2019. All patients underwent standard prone mini PCNL with 15Fr amplatz with 80 cases of fluoroscopic and 12 cases of ultrasound guided access. In three cases of tortuous ureters, wire was passed via retrograde catheter and retrieved via amplatz to straighten the ureter. Calculi fragmented with laser.

A total of 77 patients were included in this study, 62 unilateral and 15 bilateral cases (92 renal units). The mean age was 45.4±13.7 years (range 17–71), male to female ratio was 61:16, the disease laterality (left: right) was 28:34. The mean stone size was 17.6±1.4 mm. Mean operative time was 22.4±1.5 min. 88% patients were discharged as day care. Complication rate was 6.5%, three patients had transient fever and two patients had distal migration of small fragments and they were extracted at the time of DJ stent removal by rigid ureteroscopy (100%).

We conclude that it is easy and effective to deal with large upper ureteric calculus when it is in a fixed position. In situ management of large upper ureteric calculus by mini-PCNL can be done safely and effectively as it is a fast procedure, prevents unnecessary manoeuvres, less complication rates and has good stone clearance rates.

• hydroureteronephrosis
• laser lithotripsy
• upper ureter stones
• urolithiasis

• Housing for the Elderly
• Ureteral Obstruction
• Ureteroscopy

• Extracorporeal shockwave lithotripsy (ESWL)
• Laparoscopic ureterolithotomy (LU)
• Large proximal ureteral stones (LPUS)
• Percutaneous nephrolithotomy (PCNL)
• Systematic review and meta-analysis
• Ureteroscopic lithotripsy (URL)

• Adult
• Female
• Humans
• Kidney/surgery
• Laparoscopy/methods
• Lithotripsy/methods
• Male
• Middle Aged
• Nephrolithotomy, Percutaneous/methods
• Randomized Controlled Trials as Topic
• Treatment Outcome
• Ureter/surgery
• Ureteral Calculi/surgery
• Ureteroscopy/methods

• Efficacy
• Percutaneous nephrolithotomy
• Safety
• Upper urinary tract stones
• Ureteroscopic lithotripsy

• Meta-analysis
• Minimally invasive percutaneous nephrolithotomy
• Retrograde intrarenal surgery
• Stone-free rate
• Upper urinary stones

The purpose of the study was to evaluate the efficacy and safety of a patented perfusion and suctioning platform and ureteral access sheath in the treatment of large ureteral stones (≥ 1.5 cm) below L4 level.

We recruited 122 patients with large ureteral stones below L4 level at our hospital from December 2014 to June 2017. The patients were randomly divided into the study and control groups. Multiple operative and perioperative parameters were compared between the two groups.

The study group had shorter operation time, less cases of postoperative fever, lower serum levels of PCT, IL-6 and BET within 24 h after surgery, as well as less number of cases receiving secondary surgery than the control group. Moreover, the former had a significantly higher stone clearance rate than the latter (P < 0.05; t-test or χ² test).

The patented perfusion and suctioning platform and ureteral access sheath are safe and effective in treating large ureteral stones (≥ 1.5 cm) below L4 level.

• Intra-luminal pressure monitoring
• Large ureteral stones
• Suctioning
• Ureteroscopic lithotripsy

• Managements
• Meta-analysis
• Proximal impacted ureteral stones
• Systematic review

• Micropercutaneous
• Micropercutánea
• Minipercutaneous
• Minipercutánea
• Nefrolitectomía percutánea
• Percutaneous nephrolithotomy

• Algorithms
• Clinical Decision-Making
• Equipment Design
• Humans
• Microsurgery
• Nephrolithotomy, Percutaneous/instrumentation
• Nephrolithotomy, Percutaneous/methods

Minimally invasive percutaneous nephrolithotomy (mini-PCNL) and retrograde intrarenal surgery (RIRS) are both alternatives for PCNL to treat renal calculi. This study is aimed at comparing the stone-free rate (SFR) and other surgery parameters of two approaches for treating upper urinary calculi. We performed this meta-analysis in September 2016 by searching studies about mini-PCNL and RIRS for treating upper urinary calculi in various databases, and RevMan v.5.3 was applied. Three randomized controlled trials and ten nonrandomized trials were included, involving a total of 1317 patients. Meta-analysis showed that mini-PCNL group led to a higher SFR [odds ratio: 1.96; 95% confidence interval: 1.46–2.64; P < 0.00001] but brought a larger postoperative decrease in hemoglobin levels compared with RIRS. RIRS provided a shorter hospital time. There was no significant difference in operation time. Higher postoperative complications were detected in the mini-PCNL, but the difference was not significant. Grade I and III complications did not vary between two procedures, but grade II complications were of lower incidence in RIRS group. In the light of these results, compared with RIRS, mini-PCNL provided significantly higher SFR and efficiency quotient for managing calculi; however, it resulted in higher incidence of postoperative complications, larger hemoglobin drops, and longer hospital stay.

To compare the safety and efficacy of rigid ureteroscopic lithotripsy (rigid URSL) and percutaneous nephrolithotomy (PCNL) in treating large proximal ureteral stones.

A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science databases was performed to find out relevant studies. After literature screening according to the predetermined inclusion and exclusion criteria, data of eligible studies was extracted and then a meta-analysis was conducted via RevMan 5.3 software.

Five randomized controlled trials (RCTs), one prospective and four retrospective cohort studies involving 837 patients were included. Patients underwent rigid URSL were associated with shorter operation time (WMD, -23.66min; 95%CI, −45.00 to -2.32; p = 0.03), shorter hospital stay (WMD, -2.76d; 95%CI, −3.51 to −2.02; p< 0.00001), lower 3rd-day (RR, 0.73; 95%CI, 0.66 to 0.82; p < 0.00001) and 1st-month (RR, 0.82; 95%CI, 0.77 to 0.87; p < 0.00001) stone-free rate, higher risk of conversion to other surgical procedures (RR, 4.28; 95%CI, 1.93 to 9.46; p = 0.0003), higher incidence of migration (RR, 28.49; 95%CI, 9.12 to 89.00; p < 0.00001) and ureteral perforation (RR, 6.06; 95%CI, 1.80 to 20.44; p = 0.004), lower risk of fever (RR, 0.64; 95%CI, 0.42 to 0.97; p = 0.04), transfusion (RR, 0.19; 95%CI, 0.04 to 0.85; p = 0.03) and hematuria (RR, 0.38; 95%CI, 0.25 to 0.57; p < 0.0001). No significant difference was observed in terms of incidence of embolization, pain and ureterostenosis. When cohort studies or studies in which flexible ureteroscopy was used as an intraoperative auxiliary procedure were excluded, we both found that most of the results kept stable.

Both PCNL and rigid URSL are safe for patients with large proximal ureteral stones while PCNL is more effective in stone clearance.

• Humans
• Lithotripsy/adverse effects
• Nephrostomy, Percutaneous/adverse effects
• Postoperative Complications/diagnosis
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Randomized Controlled Trials as Topic
• Urinary Calculi/surgery
• Urinary Calculi/therapy

Urinary stones are common medical disorders and the treatment of impacted proximal ureteral stones (IPUS) is still a challenge for urologists. The aim of this study was to compare the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MI-PCNL) and ureteroscopic lithotripsy (URL) in the treatment of IPUS via a meta-analysis.

We collected studies using PubMed, Embase, and Cochrane Library from 1978 to November 2016 and analyzed them using Stata 12.0 and RevMan 5.3. Odds ratios (ORs) and standard mean difference (SMD) were calculated for binary and continuous variables respectively, accompanied with 95% confidence intervals (CIs). All study procedures followed the PRISMA guidelines.

Five prospective studies were included in our meta-analysis, with 242 MI-PCNL and 256 URL cases. MI-PCNL was associated with a longer postoperative hospital stay than URL (SMD, 3.14; 95% CI, 1.27 to 5.55). However, no significant difference was observed in operative time (SMD, -0.38; 95% CI, -3.15 to 2.38). In addition, MI-PCNL had higher initial (OR, 11.12; 95% CI, 5.56 to 22.24) and overall stone-free rates (OR, 8.70; 95% CI, 3.23 to 23.45) than URL, along with lower possibilities of surgical conversion (OR, 0.11; 95% CI, 0.03 to 0.49) and postoperative shock wave lithotripsy (OR, 0.06; 95% CI, 0.02 to 0.18). Regarding complications, no significant differences were observed between MI-PCNL and URL (OR, 1.39; 95% CI, 0.93 to 2.10), except for hematuria (OR, 4.80; 95% CI, 1.45 to 15.94).

MI-PCNL is optimal and should be considered as the preferred treatment method for IPUS, as it has better efficacy and a safety profile similar to that of URL. However, further high quality studies with larger sample size are required in future.

• Humans
• Minimally Invasive Surgical Procedures/methods
• Nephrostomy, Percutaneous/methods
• Treatment Outcome
• Ureteral Calculi/surgery

• National Natural Science Foundation of China
• Science and Technology Planning Project of Liaoning Province

Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones. Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques. Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients' demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p = 0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p < 0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p < 0.001). No difference was found between the groups (p = 0.745) regarding postoperative complications. Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization.

Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is recommended for staghorn calculi, kidney stones larger than 2 cm, and shock wave lithotripsy-resistant lower pole stones greater than 1 cm. However, except for open and laparoscopic surgery, PCNL is the most invasive of the minimally invasive stone surgery techniques. Over the years, technical and instrumental advances have been made in PCNL to reduce morbidity and improve effectiveness. A thorough review of the recent literature identified five major areas of progress for the advancement of PCNL: patient positioning, method of percutaneous access, development of lithotriptors, miniaturized access tracts, and postoperative nephrostomy tube management. This review provides an overview of recent advancements in PCNL and the outcomes of each area of progress and notes how much we achieve with less invasive PCNL. This information may allow us to consider the future role and future developments of PCNL.

• Kidney calculi
• Minimally invasive surgical procedures
• Percutaneous nephrostomy
• Supine position
• Surgical instruments

The aim of this review is to present the most recent data regarding the indications of mini percutaneous nephrolithotomy (PCNL), the results and the complications of the method. Medline was searched from 1997 to January 2014, restricted to English language. The Medline search used a strategy including medical subject headings and free-text protocols. PCNL is a well-established treatment option for patients with large and complex renal calculi. In order to decrease morbidity associated with larger instruments like blood loss, postoperative pain and potential renal damage, a modification of the technique of standard PCNL has been developed. This is performed with a miniature endoscope via a small percutaneous tract (11–20 F) and was named as minimally invasive or mini-PCNL. This method was initially described as an alternative percutaneous approach to large renal stones in a pediatric patient population. Furthermore, it has become a treatment option for adults as well, and it is used as a treatment for calculi of various sizes and locations. However, the terminology has not been standardized yet, and the procedure lacks a clear definition. Nevertheless, mini-PCNL can achieve comparable stone-free rates to the conventional method, even for large stones. It is a safe procedure, and no major complications are reported. Although less invasiveness has not been clearly demonstrated so far, mini-PCNL is usually related to less blood loss and shorter hospital stay than the standard method.

• Complications
• mini percutaneous nephrolithotomy
• modified Clavien system
• stone-free rate
• urolithiasis

To investigate the best treatment option for large upper ureteral stone, percutaneous nephrolithotomy or laparoscopic ureterolithotomy. We searched three key word of upper ureteral stone, laparoscopic ureterolithotomy, percutaneous nephrolithotomy in PubMed, Scopus and Ebsco. We found approximately twenty suitable articles about this subject since January 1980 until January 2014. All articles studies and reviewed meticulously and brief review of these articles was written and some Ideas of experts was added. In many studies, it is suggested that success rate and complications of laparoscopic ureterolithotomy and percutaneous nephrolithotomy are the same, but percutaneous nephrolithotomy has less hospital stay time, duration of surgery and it is more cost effective. Overall it seems that percutaneous nephrolithotomy for treatment of upper ureteral stones is preferable rather than laparoscopic ureterolitothomy

• Upper ureteral stones
• Percutaneous nephrolithotomy
• Laparoscopic ureterolithotomy
• Laparoscopy
• Ureteral calculi