Technical refinements in percutaneous nephroureterolithotomy

Area of Science:

• Urology
• Minimally Invasive Surgery

Background:

• Percutaneous nephrostolithotomy and ureterolithotomy are standard treatments for upper urinary tract calculi.
• Procedure success hinges on optimal percutaneous nephrostomy track creation.
• Unobstructed collecting systems or interfering calculi can complicate nephrostomy.

Purpose of the Study:

• To present technical refinements for percutaneous nephrostolithotomy and ureterolithotomy.
• To detail methods that enhance the success of these procedures.

Main Methods:

• External abdominal compression for collecting system distention and renal puncture.
• Ureteral distention for percutaneous calculus extraction.
• Kidney repositioning for improved access.
• Targeting opaque caliceal calculi for puncture.
• Saline flush for accurate needle placement.
• Accelerated track dilatation with semirigid fascial dilators.

Main Results:

• Over 200 successful nephrostomies and ureterolithotomies performed.
• Refinements facilitate procedures in challenging cases.
• Air contrast for postprocedural nephrostography is discussed.

Conclusions:

• Technical advancements significantly improve percutaneous stone removal outcomes.
• These refinements offer solutions for difficult percutaneous nephrostolithotomy and ureterolithotomy cases.