Abstract: Objective To explore the safety and clinical efficacy of the balloon dilatation establishing standard percutaneous nephrolithotomy(PCNL) channel under holmium laser treatment for complex upper urinary tract stones. Methods Selected the clinical data of 38 patients in the Affiliated Hospital of Hebei University(20 females and 18 males, the average age is 38.3 years) with complex upper urinary tract calculi who were treated by the holmium laser under the balloon dilation establishing standard PCNL channel, including 15 cases of upper calyx diverticular calculi, 15 cases of light diverticulum kidney stones and 8 cases of renal and upper ureteral stones. The stones diameter was 2.0-4.2 cm, average 2.8 cm. All patients were treated with the holmium laser, punctured by ultrasound-guided. Results One case was difficult to establish the channel due to light obvious hydrocephalus and was re-established the channel. The renal access was successfully established in 37 patients and the stones were cleared out in all cases in the first stage of treatment, the calculus clearance rate was 100%. Postoperative examination of 38 patients had no residual stones. The operation duration was 30-98 minutes, averaged 45 minutes. The blood loss was 10-65 mL, averaged 25 mL. There were no serious complications and no cases converting to open surgery cases. The length of postoperative hospital stay was 7-14 days. conclusion The balloon dilatation establishing standard PCNL channel, and holmium laser lithotripsy has the advantages of fewer trauma, less bleeding, high stone clearance rate, shorter operative time and provides a better treatment for patients with upper urinary tract stones.

Key words: balloon dilatation, percutaneous nephrolithotomy, holmium laser, complex upper urinary tract calculi