Percutaneous Nephrolithotomy or Intracorporeal Lithotripsy: Which is the Better Surgical Option for Impacted Large Upper Ureteric Stones?

Introduction: The management of patients with large impacted upper ureteral stones is difficult, there is no standard treatment. We compared the outcomes of percutaneous nephrolithotomy (PCNL) and intracorporeal lithotripsy (ICL) to treat large (1.5 cm), impacted, upper ureteral stones. Methods: In total, 82 patients with large impacted upper ureteral stones were included in this study. Of these patients 40 underwent intracorporeal lithotripsy (ICL) and 42 underwent percutaneous nephrolithotomy (PCNL). The inchesion criteria were: longest diameter of stone 1.5 cm, the localization of stone between the lower border of L4 spine and ureteropelvic junction and impacted stone. Results: In the intracorporeal lithotripsy (ICL) group, we were unable to reach the stone in 3 patients because of ureteral stricture and edema, of these 3 patients; we were unable to optimally visualize the stone in 2 patients due to bleeding and mucosal injuryand could not be reached in the third patient. Also in the intracorporeal lithotripsy (ICL) group, 14 patients had stones or big fragments which migrated into the renal collecting system. In the PCNL group, 21 patients had concurrent renal stones. Conclusion: The recent study we found that PCNL is a safe and effective minimally invasive procedure with acceptable complication rates in the treatment of patients with impacted upper ureteral stones. Keywords: PCNL, ESWL. Intracorporeal lithotripsy (ICL), Upper ureterioc stone, Impacted stone,Renal stone