PLANING RENAL PUNCTURE IN MINI-PERCUTANEOUS NEPHROLITHOTOMY:A RADIOLOGICAL ANATOMYBASED INTERVENTION

Abstract

Objectives: To determine the outcome of mini-PCNL in terms of stone clearance considering renal puncture through diff erent calyces under fl uoroscopy.Materials and Methods: This study was conducted in the Department of Urology Institute of Kidney Diseases , Peshawar from 1st Jan 2022 to 31st May 2022. Patients fulfi lling the study criteria having renal stone≥2cm were recruited for the study. All the patients having abnormal blood caogulopathy and abnormal anatomy were excluded from the study. The cystoscopy was performed fi rst by keeping the patient in the lithotomy position and the ureteric catheter was passed. The anatomy of kidney is fully visualized targeting the calyx with gradual descent technique under fl uoroscopic guidance. Renal access to pelvicalyceal (PVC) system achieved percutaneously under fl uoroscopic guidance by renal puncture through diff erent calyces after which which guide wire was passed. The percutaneous tract was made and dilated up to 17Fr by using single-step metalic dilator and a 12-Fr-sized nephroscope was used. The stones were broken into pieces using pneumatic lithoclast.Results: Mean stone size was 15.35+3.073. Mean hospital stay was 2.62+0.487. Ninety six(60%) were male patients while 64 (40%) were female patients. 71.9%(115) patients achieved stone clearance by intervention through middle calyx while 21.85% (35) and 7%(10) patients achieved full stone clearance through upper and lower calyx approach respectively.Conclusion: The approach to the pelvicalyceal system through proper planning of renal puncture under fl uoroscopic guidance turns signifi cantly good in case of middle calyceal approach in terms of stone clearance.