Percutaneous Retrieval of Upper Urinary Tract Foreign Bodies and Calculi

ABSTRACT

PURPOSE: To determine, when extracorporeal shockwave lithotripsy is contraindicated, the usefulness and safety of percutaneous management in the removal from the upper urinary tract of foreign bodies and calculi, or small remnants of these, retained affer percutaneous nephrolithotomy. MATERIALS AND METHODS: Between January 1996 and May 2001, we attempted to retrieve foreign bodies or calculi from the upper urinary tract of 20 patients, using various percutaneous techniques. There were eleven foreign bodies, namely fragmented nephrostomy catheters (n=2), migrated ureteric stents inaccessible to retrograde ureteroscopic management (n=8), and one metallic radiopaque marker which was separated from the pusher of the internal ureteral stent. Nine urinary tract calculi were present. These ranged in radiographically measured size from 4 to 8 mm in their largest diameter, and were found in the renal pelvis or calyx (n=5) and ureter (n=4). After percutaneous nephrostomy, all procedures involved the use of a 7-F to 14-F sheath, inserted under fluoroscopic guidance. Devices used for the retrieval of these objects include a stone basket retriever, loop snare, grasping forceps, and balloon catheter. RESULTS: In all cases except one, it was possible to retrieve calculi or other items from the upper urinary tract. No surgical procedure was required and no significant complications were encountered in any of the cases during or after the procedures. CONCLUSION: The percutaneous technique can be useful and safe in the management of foreign bodies or calculi present in the upper urinary tract.