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Retrograde upper-pole calyceal access for percutaneous nephrolithotripsy of stones in the lower-pole calyx.

Al-Otaibi KM - Arab J Urol (2012)

Bottom Line: The residual stone fragments (2-4 mm) in the remaining six patients (8%) were considered insignificant.Upper-pole calyceal access for PCNL provides easy and effective clearance of stones in the lower calyx.This access should be considered for PCNL of single or multiple stones in the lower calyx.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Dammam, Dammam, Kingdom of Saudi Arabia.

ABSTRACT

Objective: To present the results of upper calyceal access during percutaneous nephrolithotripsy (PCNL) for stones in the lower calyx, as PCNL is considered the most effective minimally invasive surgery for managing lower calyceal stones, with percutaneous access either directly to the lower calyx or through an upper or middle calyx.

Patients and methods: The study included 76 patients with single (51) and multiple (25) stones in the lower calyx, and stones in the lower calyx plus renal pelvis (six) and associated pelvi-ureteric junction obstruction (PUJO, five). They were managed by PCNL using retrograde access through the upper-pole calyx in addition to laser endopyelotomy for the PUJO.

Results: The mean duration required for establishing the retrograde nephrostomy tract was 14.4 min, and for completing the procedure was 40 min. The mean fluoroscopy exposure time was 3.2 min. Access from the upper calyx allowed easy and rapid advancement of the nephroscope to the lower calyx. The stones varied in size, at 10-25 mm. Stones were cleared completely in 70 of the 76 patients (92%); the stone-free rate was 100%. The residual stone fragments (2-4 mm) in the remaining six patients (8%) were considered insignificant. Complications were minor in four patients (5%), and included pleural effusion in two, bleeding in one and an arteriovenous fistula in one.

Conclusions: Upper-pole calyceal access for PCNL provides easy and effective clearance of stones in the lower calyx. This access should be considered for PCNL of single or multiple stones in the lower calyx.

No MeSH data available.


Related in: MedlinePlus

Fluoroscopy-guided retrograde puncture of the upper calyx.
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f0005: Fluoroscopy-guided retrograde puncture of the upper calyx.

Mentions: Under fluoroscopic control all punctures were made during inspiration, where the kidney is pushed down, and the goal was to obtain subcostal access. The puncture wire was advanced from the lumen of the upper calyx into the kidney parenchyma and body wall in a horizontal plane to the skin (Fig. 1). The posterior axillary line was used as a landmark on the skin for the emergence of the puncture wire. A small skin incision was made over the protruding skin area by the puncture wire, allowing it to exit through that incision.


Retrograde upper-pole calyceal access for percutaneous nephrolithotripsy of stones in the lower-pole calyx.

Al-Otaibi KM - Arab J Urol (2012)

Fluoroscopy-guided retrograde puncture of the upper calyx.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4442947&req=5

f0005: Fluoroscopy-guided retrograde puncture of the upper calyx.
Mentions: Under fluoroscopic control all punctures were made during inspiration, where the kidney is pushed down, and the goal was to obtain subcostal access. The puncture wire was advanced from the lumen of the upper calyx into the kidney parenchyma and body wall in a horizontal plane to the skin (Fig. 1). The posterior axillary line was used as a landmark on the skin for the emergence of the puncture wire. A small skin incision was made over the protruding skin area by the puncture wire, allowing it to exit through that incision.

Bottom Line: The residual stone fragments (2-4 mm) in the remaining six patients (8%) were considered insignificant.Upper-pole calyceal access for PCNL provides easy and effective clearance of stones in the lower calyx.This access should be considered for PCNL of single or multiple stones in the lower calyx.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, University of Dammam, Dammam, Kingdom of Saudi Arabia.

ABSTRACT

Objective: To present the results of upper calyceal access during percutaneous nephrolithotripsy (PCNL) for stones in the lower calyx, as PCNL is considered the most effective minimally invasive surgery for managing lower calyceal stones, with percutaneous access either directly to the lower calyx or through an upper or middle calyx.

Patients and methods: The study included 76 patients with single (51) and multiple (25) stones in the lower calyx, and stones in the lower calyx plus renal pelvis (six) and associated pelvi-ureteric junction obstruction (PUJO, five). They were managed by PCNL using retrograde access through the upper-pole calyx in addition to laser endopyelotomy for the PUJO.

Results: The mean duration required for establishing the retrograde nephrostomy tract was 14.4 min, and for completing the procedure was 40 min. The mean fluoroscopy exposure time was 3.2 min. Access from the upper calyx allowed easy and rapid advancement of the nephroscope to the lower calyx. The stones varied in size, at 10-25 mm. Stones were cleared completely in 70 of the 76 patients (92%); the stone-free rate was 100%. The residual stone fragments (2-4 mm) in the remaining six patients (8%) were considered insignificant. Complications were minor in four patients (5%), and included pleural effusion in two, bleeding in one and an arteriovenous fistula in one.

Conclusions: Upper-pole calyceal access for PCNL provides easy and effective clearance of stones in the lower calyx. This access should be considered for PCNL of single or multiple stones in the lower calyx.

No MeSH data available.


Related in: MedlinePlus