Percutaneous removal of caliceal and other "inaccessible" stones: results

Percutaneous removal of renal stones (percutaneous nephrolithotomy) is becoming an established procedure, especially for stones lying free in the renal pelvis. However, some renal stones, particularly caliceal stones, are less accessible and, therefore, more difficult by the percutaneous route. We removed percutaneously 95 caliceal or otherwise poorly accessible renal stones from 53 patients with a variety of techniques, including percutaneous puncture above the 12th rib, double or Y percutaneous nephrostomy tracts, rigid and flexible endoscopy, and intrarenal cutting with diathermy. Intravenously assisted local anesthesia was used exclusively in 89 per cent of the patients. Status free of stones was achieved in all but 1 patient who retained 2 small fragments. The average number of sessions was 1.89 and the average hospital stay was 7.9 days. Complications were minor except for 1 patient who required tertiary renal artery embolization for bleeding. Illustrative cases are presented. Virtually all renal stones can be removed percutaneously.