title: Percutaneous ureterolithotomy: direct method for removal of impacted ureteral stones.
abstract: OBJECTIVE
  We report 52 percutaneous urterolithotomies in 51 patients having large, impacted middle ureteral stones. Direct percutaneous stone removal can be performed as successfully as in cases of renal stones treated with percutaneous nephrolithotomy.
  
  
  METHODS
  The operation is performed under local anesthesia; therefore, the procedure is quicker and simpler than the laparoscopic or retroperitoneoscopic intervention. All patients became stone free. In two patients (4%), ultrasound disintegration was necessary; in the remaining cases, there was no need for any fragmentation: the stone was removed intact. A retroperitoneal drain was always left at the end of the procedure. With the exception of two cases, the ureter was always stented without closure of the ureteral incision.
  
  
  RESULTS
  Fever (> or = 38 degrees C) was observed in 15 patients (29%) for 2 days. Retroperitoneal hematoma 5 cm in diameter was seen in one patient. One patient had urine leakage through the retroperitoneal drain in the postoperative period for 18 days. Also, one patient came back 3 days after discharge with urine leakage through the percutaneous retroperitoneal tract.
  
  
  CONCLUSIONS
  Direct percutaneous ureterolithotomy is an effective way to remove impacted middle ureteral stones but is advisable only for endourologists with considerable experience.
authors.affiliation: Department of Urology, University of Debrecen, Medical and Health Science Center, Hungary. cstoth@jaguar.dote.hw
authors.forename: C S
authors.initials: CS
authors.lastname: Tóth
authors.forename: A
authors.initials: A
authors.lastname: Varga
authors.forename: T
authors.initials: T
authors.lastname: Flaskó
authors.forename: B
authors.initials: B
authors.lastname: Tállai
authors.forename: M A
authors.initials: MA
authors.lastname: Salah
authors.forename: I
authors.initials: I
authors.lastname: Kocsis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000009:adverse effects; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects; D019106:Postoperative Hemorrhage / Q000209:etiology; D012187:Retroperitoneal Space; D014463:Ultrasonography; D014514:Ureteral Calculi / Q000175:diagnosis / Q000601:surgery*; D014567:Urography