Safety and efficacy of Mini-Percutaneous Nephrolithotomy in the treatment of large impacted Proximal Ureteral Stones

The management of large, impacted upper ureteric calculi remains challenging for urologists. Various treatment options include extracorporeal shock wave lithotripsy (ESWL), ureterorenoscopic lithotripsy (URSL), percutaneous nephrolithotripsy (PCNL), laparoscopic and open ureterolithotomy. ESWL has poor overall success rate in the treatment of large stones with a significant possibility of residual fragments. Semi-rigid or flexible ureterorenoscopy with Holmium: YAG laser lithotripsy (URSL) has a stone-free rate of 89-100% in managing proximal ureteral calculi [1-7]. However, large and impacted proximal ureteral stones are difficult to approach. PCNL was introduced as an alternative treatment for large renal and proximal ureteric stones and achieved success in the 1980s [8]. The modified version of PCNL using a miniature endoscope by way of a small access tract, can be routinely performed to manage stones in the kidney and proximal.