Abstract
BACKGROUND: Percutaneous nephrolithotomy (PCNL) was established as a minimally invasive treatment option for kidney stones in the 1970s and is considered a safe and effective procedure, with stone clearance rates of 78-95%. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free status and minimize the risk of complications. CLINICAL CASE: We present the case of a 36-year-old male patient with bilateral lower back pain. A CT urography scan was performed that revealed bilateral lithiasis. The stone on the right side was consistent with an incomplete staghorn stone and a right retrorenal colon was identified. Left flexible nephrolithotripsy and subsequent right percutaneous nephrolithotomy were performed. A puncture was made under fluoroscopic guidance supported by previous digital dissection of all layers of the abdominal wall until gaining access to the retroperitoneum. Colonic lesion was prevented and a tunnel through which the renal unit could be palpated was formed. CONCLUSIONS: The technique of digital insertion and dissection offers safe access to the renal unit that is useful in patients presenting with risk factors for a potential complication. KEYWORDS: Digital; Kidney; Lithiasis; Percutaneous nephrolithotomy.
Highlights
The technique of digital insertion and dissection offers safe access to the renal unit that is useful in patients presenting with risk factors for a potential complication
Kidney stone disease has been described since the time of Hippocrates
Adequate access to the renal collecting system, whether in the prone position, supine position, or any of the modified positions, is one of the most important aspects required for successful surgery.[8]
Summary
Obtaining optimal renal access and dilation are crucial in percutaneous nephrolithotomy and are difficult tasks for many urologists. Careful patient selection and accurate positioning are essential. We believe that the technique described above offers more secure access to the renal unit and is highly useful in patients with risk factors for potential complications. The experience at our hospital center has been favorable. Further study is needed to confirm the benefits of this technique over those of the standard procedure
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