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Related Experiment Videos

Flexible ureteroscopically assisted percutaneous renal access

M Grasso1, G Lang, F C Taylor

  • 1Division of Urology, Loma Linda University, California, USA.

Techniques in Urology
|April 1, 1995
PubMed
Summary
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Combining retrograde flexible ureteroscopy with percutaneous puncture offers precise antegrade renal access for complex kidney stones. This minimally invasive technique aids in challenging cases, including obese patients and those with prior access failures.

Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Endourology

Background:

  • Percutaneous nephrolithotomy (PCNL) is effective for large kidney stones.
  • Achieving precise renal access for PCNL can be challenging in patients with specific anatomical variations or previous surgical attempts.
  • Minimally dilated collecting systems and complex stone burdens require advanced techniques for successful intervention.

Purpose of the Study:

  • To evaluate the efficacy of combining retrograde flexible ureteroscopy with simultaneous percutaneous puncture for precise antegrade renal access.
  • To facilitate percutaneous access in selected patients with challenging renal anatomy or stone burdens.
  • To improve the safety and efficiency of percutaneous renal access in difficult cases.

Main Methods:

Related Experiment Videos

  • A combined retrograde and antegrade approach was utilized in patients with minimally dilated collecting systems and complex stone burdens.
  • Flexible ureteroscopy was employed to guide percutaneous puncture under direct vision.
  • A through-and-through guidewire was established using a ureteroscopically positioned snare for subsequent tract dilation and nephrolithotomy.

    • Main Results:

    • The technique was applied to seven patients with difficult percutaneous access due to renal disease, obesity, or prior failed attempts.
    • Complex stone burdens included staghorn calculi and caliceal diverticular calculi.
    • Percutaneous renal access was successfully achieved in all cases in under 30 minutes.

    Conclusions:

    • Simultaneous retrograde flexible ureteroscopy and percutaneous puncture provide precise access to complex renal collecting systems.
    • This combined approach facilitates the establishment of a through-and-through safety guidewire, crucial for subsequent procedures.
    • The technique offers a valuable solution for challenging percutaneous renal access scenarios.