Abstract：Objective:To introduce a modified method for difficult ureteral stenting in percutaneous nephrolithotomy (PCNL) via inferior calyx approach.Methods:Firstly a 0.038-in. zebra guidewire was retrogradely introduced through the previously indwelled ureteral catheter and grasped out of the work sheath by a ureteroscopic forcep to develop a through-and-through guidewire; then 8Fr guide catheter was inserted antegradely over the guidewire into the ureter after removing the prior ureteral catheter; subsequently the zebra guidewire was removed and antegradely introduced into the bladder through the guide catheter, followed by antegradely indwelling of a double J stent.Results:Between April 2006 and August 2012, a total of 628 patients underwent PCNL via inferior calys and 162 patients needed modified ureteral stenting. The lower pole infundibulopelvic angle (LPIA) was measured in 55 patients with and 57 patients without modified stenting. The results showed LPIA in patients with modified stenting was much smaller than that in patients without modified stenting (54.0±11.5) and (77.4±11.4), (P<0.000 1).Conclusions:Modified technique is simple, time saving, less invasive and high successful for difficult ureteral stenting in PCNL via inferior calyx. When LPIA was smaller than 60, modified technique should be recommended.
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