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Original Article

J Liaquat Uni Med Health Sci. 2012; 11(3): 167-171


Push and Perc

Jai Pal Paryani, Shafique-ur-Rehman Memon, Zakir Hussain Rajpar, Mohammad Shahzad Laghari.

Abstract
OBJECTIVE: To document the feasibility and clearance rate of Percutaneous Nephrolithotomy
for proximal ureteric stones.
PATIENTS AND METHODS: This was a retrospective review of patients who presented with upper
ureteric calculi of 1.5 cm or more at Department of Urology Liaquat University of Medical &
Health Sciences Jamshoro which is one of the busiest Urology centre in Sindh. Patientís demographic
data, clinical presentation, radiological findings, operative finding and clearance were
noted on a proforma.
All patients who had preoperatively urinary tract infections were treated with appropriate antibiotics.
Those who presented with urosepsis, raised creatinine and hydronephrotic kidneys underwent
percutaneous nephrostomy tube to drain the infected urine and optimize for definite
treatment. Before puncturing the kidney, stones were pushed back in the kidney with the help of
ureteric catheter and ureteroscope. Open ended 5 Fr ureteric catheter placed for opacification
of pelvicalyceal system followed by percutaneous nephrolithtomy procedure. Data was analyzed
on SPSS version 16.
RESULTS: From January 2006 to December 2010, Percutaneous Nephrolithotomies were performed
for 101 patients with upper ureteric stone. There were 70 males and 31 females with
mean age of 26 years. The location of stone(s) confirmed and function of the kidneys were assessed
with an Intravenous Urogram or CT Kidney Ureter and Bladder. Majority of patients had
gross hydronephrosis with a stone diameter ranging from 1.5cm to 2.6cm with mean of 1.9 cm
in size. Percutaneous Nephrolithtomy was the modality of treatment. At the end of the procedure
18 Fr nephrostomy or 6fr Double J Stent was left for all the patients, which was removed
after 2 and 14 days respectively.
Post -operative x-ray KUB or Ultrasound KUB was done to confirm the clearance. Complete
clearance was noted in 99 (98.7%) patients. Regarding complications, 2 patients had post-PCNL
Urosepsis and 4 patients required blood transfusions secondary to hemorrhage.
CONCLUSION: Percutaneous Nephrolithotomy is safe, economical and effective method in
treating impacted upper ureteric stone.

Key words: stone clearance, upper ureteric calculi



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