Percutaneous removal of renal and ureteral stones with and without concomitant transurethral manipulation by a urologist using antegrade and retrograde techniques without a radiologist's assistance.

Single-stage percutaneous removal of 59 ureteral and 72 renal stones, with or without transurethral manipulation, was performed in 84 of 85 consecutive patients without the assistance of a radiologist. The Hawkins-Hunter retrograde nephrostomy technique was modified by anchoring the catheter in the renal parenchyma, which prevented displacement from the targeted calix by the puncturing needle. Retrograde nephrostomy (76 patients) or percutaneous puncture (7) was established, for a combined access rate of 99 per cent in 83 patients (2 of the 85 had prior tube placement). Only 1 patient (early in the series in 1982) required an open operation because of percutaneous access failure. Tomography showed that the targeted calculi were removed completely from 61 of 66 patients (92 per cent) with uncomplicated stones and 13 of 19 (68 per cent) with complicated stones. The patients left with fragments have remained asymptomatic for a mean followup of 2.6 years. Because the concomitant use of transurethral and percutaneous approaches to stone removal was facilitated by retrograde nephrostomy, all 59 ureteral stones were removed completely from 46 patients. The mean postoperative hospital stay was 2.6 days for 66 patients with uncomplicated stones and 8.2 days for 19 with complicated stones. The Hawkins-Hunter retrograde nephrostomy technique is the preferred method to establish the tract; it facilitates simultaneous transurethral stone manipulation and the assistance of a radiologist is not essential for safe and effective nephrostolithotomy.