PCNL: tips and tricks in targeting, puncture and dilation.

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) requires effective and safe percutaneous access for successful outcomes.
• The selection of the puncture site is a critical factor influencing the procedure's success and complication rate.

Purpose of the Study:

• To highlight the importance of puncture site selection in PCNL.
• To discuss the role of preoperative and intraoperative imaging in guiding percutaneous access.
• To present a preferred surgical approach for PCNL.

Main Methods:

• Utilizing preoperative imaging for initial approach planning.
• Employing intraoperative retrograde pyelography with an occlusion balloon catheter for precise access.
• Performing ultrasound-guided renal puncture with retrograde dilation for detailed collecting system visualization.
• Routinely using a single subcostal lower pole access, targeting a specific anatomical space.
• Confirming correct needle placement with radiological signs.
• Employing Amplatz fascial dilators and balloon hydraulic dilators for tract creation.

Main Results:

• A specific subcostal lower pole access, located within a defined anatomical "danger zone," is associated with reduced non-hemorrhagic complications.
• Intraoperative retrograde pyelography and ultrasound guidance provide essential anatomical details for safe and effective access.
• The choice of dilation devices, such as Amplatz dilators and balloon hydraulic dilators, contributes to the percutaneous tract creation.

Conclusions:

• Optimal puncture site selection, guided by intraoperative imaging, is paramount for successful and safe PCNL.
• A single subcostal lower pole access, carefully chosen, can minimize procedural risks.
• The described techniques and devices facilitate effective percutaneous tract creation for PCNL.