OPTIMAL TREATMENT APPROACHES FOR STONES OF THE PELVIURETRIC JUNCTION

Abstract

Stones of the pelviureteric junction (PUJ) represent a distinct clinical entity in urolithiasis due to their unique anatomical location and potential association with functional obstruction. Optimal management of PUJ stones remains challenging and requires individualized treatment strategies based on stone characteristics, anatomical considerations, renal function, and patient-related factors. This review-based original scientific article aims to evaluate and compare current treatment modalities for PUJ stones, including extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (URS), percutaneous nephrolithotomy (PCNL), laparoscopic and robotic-assisted approaches, with particular emphasis on treatment outcomes, complications, and stone-free rates. Evidence from recent clinical studies demonstrates that no single method is universally optimal; rather, a tailored approach yields superior outcomes. Advances in endourological techniques and imaging have significantly improved success rates while minimizing morbidity. The article highlights current guidelines, proposes an evidence-based treatment algorithm, and discusses future directions in the management of PUJ stones.