Therapy for renal calculi via percutaneous nephrostomy: dissolution and extraction

Nephrostomy catheters offer nonsurgical modes of therapy for some renal stones. Continuous lavage of the stones using hemiacidrin (Renacidin) for struvite stones, THAM-E or acetylcysteine for cystine stones, and bicarbonate solution for uric acid stones may dissolve either entire stones or stone fragments remaining after surgery. Although irrigation is not without potential complications, recent developments in technique have minimized these. Nephrostomy tubes can also be used to transmit stone baskets through steerable catheters to snare stones from the upper collecting system or from the ureter; any stone that can be engaged and withdrawn through the tube tract can be removed; stones larger than those which can be safely extracted through the ureterovesical junction can be so treated. Neither of these procedures requires general anesthesia, the rate of serious morbidity is low, and the required hospital stay is often less than that for surgery; these modes of therapy are therefore valuable for certain patients.