Percutaneous nephrolithotomy and antegrade ureteroscopy

Retrograde ureteroscopy has become a mainstay in the treatment of ureteral and renal calculi. Over the past decade there has been a dramatic increase in the numberof retrograde ureteroscopic procedures performed for stone disease due to both high postoperative stone-free rates and low incidence of complications. Thus, it is not surprising that ureteroscopy is gaining acceptance as the primary treatment modality for upper tract stone disease. However, there are certain circumstances when retrograde ureteroscopy is not successful or feasible, such as altered anatomy or very large stone size. In such circumstances, alternate treatment options must be considered. Antegrade ureteroscopy (URS) performed through a percutaneous approach is often a useful treatment option for proximal and mid-ureteral calculi when retrograde URS is not possible. The following chapter will discuss a brief history of percutaneous ureteral stone surgery, modern uses of antegrade URS, indications for antegrade URS, a description of current technique, and a discussion of postoperative management.