Synchronous Twin-Tract Percutaneous Nephrolithotomy

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) is the standard technique for management of large renal calculi. Our main goal is to achieve complete stone clearance, which can be attained in single stage or multiple stages. Large bulk stone clearance by PCNL has considerable morbidity, namely, prolonged operative times, increased intraoperative blood loss, and need for secondary procedures. Therefore, to further minimize morbidity and to achieve maximum stone clearance for these difficult stones, we investigated the feasibility of a synchronous twin-tract approach. Patient and Methods: Thirty-six-year-old man presented with right ureteric and left complete staghorn calculus. He underwent right pushbang for the ureteric stone earlier and underwent synchronous twin-tract PCNL for the left complete staghorn calculus. Initial ultrasound-guided localization and puncture was achieved in the upper and lower calix, and both the tracts were dilated synchronously. PCNL was performed by two operative surgeons simultaneously. Results: Complete stone clearance was achieved. Total operative time was 80 mins and hemoglobin drop was 1.5 gm%. There were no intra- or perioperative complications noted. Postoperative X-ray confirmed complete clearance. Conclusion: Synchronous twin-tract PCNL is a potentially ideal operation for complete clearance of large bulk renal calculi with minimal morbidity. There is a need for two experienced operating teams working in tandem with two sets of endoscopic equipment, energy sources, and television monitors, which would limit this technique to hospitals where these logistics can be met. No competing financial interests exist. Runtime of video: 5 mins 46 secs