Retrograde percutaneous nephrolithotomy using the Lawson technique for management of complex nephrolithiasis

Percutaneous nephrolithotomy remains an important technique for managing complicated nephrolithiasis. Retrograde percutaneous nephrostomy creation has been promoted as an alternative to the standard antegrade technique. We reviewed our first 41 consecutive attempts utilizing the Lawson technique for managing patients with complicated nephrolithiasis. Percutaneous access was achieved in 40 attempts (98%). Thirty-six (90%) of the retrograde nephrostomy tracts were adequate for lithotripsy or stone extraction during the same anesthetic. Twenty-three (56%) of the kidneys treated with the Lawson procedure were rendered stone free. Nine patients had minimal residual stone burden (fewer than five fragments, 4 mm or smaller) by the time of discharge. A single Lawson procedure rendered 10 kidneys (24%) stone free. An additional 20 clinic procedures and 17 anesthetic procedures were performed on the 40 kidneys. Complications were minimal, with three patients (8%) requiring transfusion.