Endoscopic-guided percutaneous nephrolithotomy (EPSL) with prone split-leg position for complex kidney stone: A case...

Area of Science:

• Urology
• Endourology
• Nephrolithiasis Management

Background:

• Optimal patient positioning for percutaneous nephrolithotomy (PCNL) remains undefined for complex stone burdens.
• This case report details the use of an endoscopic-guided PCNL in a prone split-leg position (ePSL) for complex left kidney stones.

Observation:

• A 43-year-old female with a history of failed open surgery and xanthogranulomatous tissue underwent standard PCNL.
• Ultrasound guidance was necessary due to excessive pelviocalyceal debris, and residual stone in the superior calyx required a secondary procedure.
• The ePSL method was employed for the second procedure, successfully fragmenting and removing the residual stone.

Findings:

• The ePSL technique allowed for complete stone removal using a pneumatic lithotripter.
• Post-procedure evaluation confirmed no residual stones, infundibulum laceration, or active bleeding.
• The prone split-leg position was selected due to operator preference, familiarity, and difficulty with upper pole access.

Implications:

• The ePSL technique provides a safe, one-step, single-access approach for complex kidney stone removal.
• This method allows for optimal utilization of endourologic equipment.
• Further long-term follow-up is needed to fully assess the effectiveness and safety of the ePSL technique.