Multiple percutaneous access routes to multiple calculi, calculi in caliceal diverticula, and staghorn calculi

For expeditious removal of multiple calculi from certain locations in the pyelocaliceal system, the use of multiple percutaneous entry routes is advocated. The accessibility of different regions of the pyelocaliceal system from different percutaneous entry sites was mapped out after experience with the percutaneous removal of 87 solitary and 37 multiple renal calculi. A technique allowing limited access to calculi in caliceal diverticula and hydrocalices distal to stenotic infundibula was used, along with a technique for percutaneous infundibuloplasty, which is necessary to ensure drainage of such obstructed calices or caliceal diverticula after percutaneous lithotripsy. In 34 of 37 patients with multiple or staghorn calculi, all calculi were eventually removed by these methods. The use of multiple entry routes did not increase the risk of reduced renal function. Moreover, improved drainage through the resultant multiple nephrostomy tubes and transinfundibular stents has reduced the incidence of postoperative septicemia.