Abstract
There have been several reports on the feasibility and safety of the superior pole approach to the kidney for percutaneous renal stone removal. To the author's knowledge, no one has published on the huge advantages this approach affords, owing to the rigid nature of the nephroscope/ultrasonic lithotripter, and due to the usually oblique position of the kidney as it lies upon the psoas. Between July 1986 and June 2014, the author has performed more than 500 percutaneous renal access procedures for stone removal at a single community hospital. Procedural technique is reviewed in detail, including the usual supremacy of the superior pole approach, the value of preprocedural sagittal computed tomographic reconstructions in forming a tentative plan of approach to the kidney, and the value of an intraprocedural partial-air nephrostogram in finalizing the plan. The importance of collaboration with the involved urologist, and knowledge of the tools available to the urologist, is emphasized.
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