TREATMENT OF LARGE IMPACTED UPPER URETERIC STONES WITH MINI-PERCUTANEOUS NEPHROLITHOTOMY (PCNL) BY ADAPTING MIDDLE CALYX APPROACH: A SINGLE CENTRE STUDY

Objective: To evaluate the role of mini-Percutaneous Nephrolithotomy through the middle calyx approach for the treatment of impacted upper ureteric calculi. Materials and Methods: This descriptive cross-sectional study was conducted between 1st August 2019 and 31st July, 2020 in which 50 patients underwent mini-PCNL through middle calyx approach using 18-Fr access sheath for impacted upper ureteric stones. Patients of either gender with impacted upper ureteric stones ≥ 15 mm were included in the study. Patients with abnormal coagulopathy state, active urinary tract infection, pregnant ladies, and abnormal upper urinary tract anatomy were excluded from the study. Post-operatively patients were evaluated radiologically. After 2 months IVU of the patients was done followed by a renal scan. Results: Ninety-six percent(48) of patients have complete clearance through a single tract. However, the stone fragments remained in the pelvicalyceal system were the residual stones floated back into the system during the whorl pool mechanism. The mean age of the patient was 34.9±12.6 years. One patient had ureteral perforation. Supra twelfth puncture was done in forty-two while in 8 patients puncture below twelfth rib was carried out. Pneumothorax occurred in one patient due to a very highly located kidney. Two patients went into sepsis. No mortality was noted. The stone-clearance rate was established as 96%. Conclusion: The impacted upper ureteric calculi (≥ 15mm) can be managed with minimally invasive techniques such as mini-PCNL by adapting the middle calyx approach using an 18-Fr access sheath. Moreover, this approach is effective with a greater stone-free rate.