Surgical technique
All patients provided written informed consent before the surgery. As a
standard procedure, pre-surgical urine cultures were obtained and
positive cultures were treated according to antibiogram.
Second-generation cephalosporins were utilized for preoperative
antibiotic prophylaxis. All of the surgeries were performed under
general anaesthesia. After the cystoscopic evaluation of the bladder, a
retrograde pyelography was performed to evaluate the upper urinary
system. A 0.035-inch safety guidewire (Sensor®, Boston
Scientific, Marlborough, MA, USA) was routinely placed. Then, the
ureteral access sheath (UAS; 10-12 Fr. Bi-Flex™, Rocamed, Monaco or
11/13 Fr. Boston Scientific, Marlborough, MA, USA) was inserted over the
working guidewire and placed just below the proximal ureter stone under
fluoroscopic guidance. The flexible ureteroscope (MARKA) was inserted
through the UAS, and a holmium: YAG laser with a 272 μm laser fibre was
used to fragment the stones. The laser energy and pulse frequency were
varied based on the stone burden, stone density and the surgeon’s
preference. Stone fragments >2 mm were extracted using a
nitinol basket catheter (Dakota®, Boston Scientific,
Marlborough, MA, USA). A 4.7 Fr. double J stent was inserted into the
urinary system and left in place for 1 to 4 weeks according to the
surgeon’s preference. During follow-up, all patients were evaluated
using kidney-ureter-bladder radiography at the postoperative first day
and low-dose CT in the postoperative first month.