Percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi

Objective To analyze the technique and clinical effect of percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi.Methods From February 2009 to May 2012,20 ureteral stenosis patients with the history of ureteral open surgery,postoperative residual or recurrent kidney renal calculi were treated.Fifteen cases were with hydronephrosis of 2-4 cm,4 cases were with hydronephrosis of 5-6 cm and 1 case was with hydronephrosis ＞ 6 cm.Subsequent calculi size ＜ 1 cm was found in 16 cases,1-3 cm in 3 cases,＞ 3 cm in 1 case.All patients were treated with percutaneous nephrolithotomy ultrasonic lithotripsy combined with balloon dilatation.The calculi clearance rate,hydronephrosis changes,complications,intraverous urography (IVP) and CT urography (CTU) situation before and after surgery were analyzed.Results All the 20 cases were completed surgery successfully.There was 1 case with renal hemorrhage 3 d after surgery and controlled with DSA hemostasis.There was 1 case accepted adjusting double-J tube by ureteroscopy.Seventeen patients'calculi were completed removed.Two cases with residual calyceal calculi size ＜ 5 mm was not further treated.There was 1 case treated with nephrectomy because of renal calculi with infection.The patients were followed up for 6-39 (12.5 ± 1.9) months.Hydronephrosis improved significant changes [2.1-4.0 (2.2 ±0.9) cm vs.2.5-7.5 (3.9 ± 1.2) cm,P ＜ 0.05].All patients achieved significant improvement in IVP and CTU comparing of preoperative and postoperative data.Conclusion The use of percutaneous nephrolithotomy combined with endoscopic balloon dilation is a safe and effective treatment option in the treatment of kidney calculi with ureteral stenosis. Key words: Nephrostomy, percutaneous;  Kidney calculi;  Ureteral disease;  Balloon dilation