Acceso percutáneo al cáliz superior en posición supina: experiencia inicial

Abstract

BackgroundThe correct choice for the percutaneous puncture site is key to the success of any percutaneous nephrolithotomy. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free rate and minimize the risk for complications. It is necessary to correctly choose the calyx to be accessed; in certain cases the upper calyx is the ideal site. AimsTo report our experience with the percutaneous approach to the upper pole with patients in the supine position. MethodsA retrospective, observational, descriptive study was carried out on patients with stones in the renal pelvis or upper calyx treated through percutaneous nephrolithotomy. ResultsA total of 17 patients were included in the study, and 17 kidney units were treated. All 17 patients (100%) underwent general anesthesia. Nine (53%) of the patients were men and 8 (47%) were women, with a mean age of 45.8 years (range: 18-72). Stone site was the right kidney in 10 (59%) patients and the left in 7 (41%). A total of 13 (76%) patients were symptomatic. The mean body mass index was 27kg/m2 (range: 20-34). ASA classification was I in 13 (76.4%) patients, II in 3 (17.6%) patients, and III in one (5.8%) patient. Eight (47%) patients underwent previous treatments. Procedure success or stone-free rate was achieved in 14 (82.3%) patients with the first treatment and in 17 (100%) with the second treatment. DiscussionCurrent knowledge of the pleural and diaphragmatic anatomy, the use of real time ultrasound for percutaneous puncture, and the development of new surgical techniques have considerably reduced the risk for intrathoracic complications. ConclusionsAccess to the upper calyx with the patient in the supine position is safe and reproducible. This approach provides excellent vision of the entire pyelocaliceal system and should be reserved for cases in which the lower calyx is not the best option.