Retrograde nephrostomy access for percutaneous nephrolithotomy: a simple and safe technique

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrolithotomy (PCNL) is a standard procedure for kidney stone management.
• Achieving optimal access is crucial for successful PCNL outcomes.
• The retrograde nephrostomy access technique offers an alternative approach.

Purpose of the Study:

• To illustrate the experience and evaluate the safety and efficacy of the retrograde nephrostomy access technique for PCNL.
• To analyze outcomes including operative time, stone clearance, and complication rates.

Main Methods:

• Retrospective study of 648 patients undergoing PCNL with retrograde nephrostomy access from June 1997 to September 2018.
• Data collected included patient demographics, operative details, access site, fluoroscopy time, stone clearance, and complications.
• Access was achieved via upper, middle, or lower calyx, with some requiring supracostal access.

Main Results:

• Average retrograde access time was 14.4 min, with an average PCNL operative time of 40 min.
• Complete stone clearance was achieved in 91.8% of patients.
• Complication rate was 6%, with no cases of colonic injury, pneumothorax, or hemothorax.

Conclusions:

• Retrograde nephrostomy access for PCNL is a safe, reliable, and effective technique.
• The method offers advantages such as controlled wire placement and minimal radiation exposure.
• Low failure and complication rates contribute to its favorable clinical profile.