Retrograde ureterolithotripsy with antegrade installation of the ureteral sheath

Introduction. Frequent problem in everyday urology practice is the management of patients with large ureteral stones and clinically significant residual fragments after PCNL of large or staghorn caliculi and ESWL as part of the subsequent "sandwich therapy". There are a lot of different surgical methods of treating large or residual ureteral caliculi, we also decided to offer our operative technique named retrograde ureterolithotripsy with antegrade installation of the ureteral sheath. Materials and methods. The study involved 24 patients who had nephrostomy drains and residual or migrated ureteral calculi. At the first stage, hydrophilic guidewire was inserted through the nephrostomy fistula, at second ureteral sheath was passed until calculus localisation. Then retrograde contact laser ureterolithotripsy was performed. As a result, fragments of calculus were "washed out" through the ureteral sheath bypassing the renal cavity system. After the completion of lithotripsy and removal of the uretheral sheath, ipsilateral ureter stenting was being performed. Results. Nobody from patients had severe complications. At the same time, the SFR was equal to 100%. Conclusion. Our experience demonstrates that antegrade ureteral sheath placement during retrograde contact laser ureterolithotripsy prevents migration of stone fragments in pelvicalyceal system and also provides excellent visualization of working field and there is no need to use disposable lithoextractors.