Application of Ureteroscopy Combined with Percutaneous Nephrolithotomy in Supine Anterolateral Lithotomy Position of the Management of Complicated Upper Ureteric Calculi

Objective: To investigate the safety and efficacy of ureteroscopy combined with percutaneous nephrolithotomy in supine anterolateral lithotomy position of the management of complicated upper ureteric calculi.Methods: From February 2011 to Febru-ary 2012,a series of 36 patients underwent ureteroscopy combined with percutaneous nephrolithotomy with the new supine position under epidural anesthesia or General anesthesia.The average age was(47±15)years,and the average bulk of the stone was(2.0±1.0) cm.We first do ureteroscopic Lithotripsy in order to broken a large stone into small gravel and push it into the renal pelvis,Under ultrasound guidance,the desired calix or pelvis was punctured near the posterior axillary line,then dilating the tract and establishing the 16 F or 24 F tract for PCNL.Results: The pelvicaliceal system could be successfully approached in all patients.The procedure was well tolerated in all patients.Mean operation time was(75±25) min.91.6%of the patients were rendered free of stones by the initial operation.Three cases had residual stones,and a second operation was performed in 1 cases to clear the residual stones.Two cases had high fever.None of the patients suffered visceral injury.Conclusion: The new supine position is safe,effective and well tolerated in patients.