title: Two-step minipercutaneous ureterolithotripsy under multimodal analgesia for complicated impacted calculi in proximal ureter.
abstract: OBJECTIVE
  To suggest minipercutaneous ureterolithotripsy using the mininephroscope as an alternative process for impacted stones of the upper ureter because these stones can be challenging to treat and can produce severe symptoms.
  
  
  METHODS
  We report our results of cases in which the percutaneous approach using 2-step minipercutaneous ureteroscopy with the mininephroscope was used to achieve relief from the stone, with minimal anesthesia risks. A total of 54 patients (33 men and 21 women) presented with impacted stones in the proximal ureter. The mean stone size was 16.2 mm (range 10-21). All patients were treated with 2-step minipercutaneous antegrade ureterolithotripsy under multimodal analgesia.
  
  
  RESULTS
  The mean operative time was 49 minutes (range 40-110). Placement of the percutaneous drainage tube was quick and was performed with the patient under local anesthesia. The minipercutaneous session followed several days later, with the patient under multimodal anesthesia. The initial stone-free rate was 94%. The stone-free rate 2 months after the procedure was 100%. All procedures were well tolerated by the patients (group mean visual analog scale score 3.1 ± 0.7 standard deviation). No severe adverse events were noted. The mean hospital stay was 5.3 days (range 3-12).
  
  
  CONCLUSIONS
  In selected emergency cases of impacted proximal ureteral stones, the approach of the initial insertion of a nephrostomy tube followed by a second session of antegrade ureterolithotripsy using the mininephroscope is a safe and effective alternative treatment, especially, because it can be accomplished with minimal anesthesia requirements.
authors.affiliation: Department of Urology, University Hospital of Larisa, Larisa, Greece.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Aravantinos
authors.forename: Theodore
authors.initials: T
authors.lastname: Anagnostou
authors.forename: Michael
authors.initials: M
authors.lastname: Samarinas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Ioannides
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Ziavliakis
authors.forename: Antonios
authors.initials: A
authors.lastname: Ntafos
authors.forename: Michael
authors.initials: M
authors.lastname: Melekos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D005260:Female; D006801:Humans; D007902:Length of Stay; D008012:Lidocaine; D008096:Lithotripsy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D010146:Pain / Q000517:prevention & control; D012189:Retrospective Studies; D014514:Ureteral Calculi / Q000628:therapy*; D018666:Ureteroscopy / Q000295:instrumentation; D055815:Young Adult
chemical_list: D000700:Analgesics; D000779:Anesthetics, Local; D008012:Lidocaine