Abstract
ABSTRACTObjectives:To evaluate the success of ultrasonography directed renal access in entering the target calyx from proper entry site and in the direction of renal pelvis during percutaneous nephrolithotomy (PCNL).Materials and Methods:PCNL cases who were operated on by one fellow from May-June 2014 were included in this study. A vertically placed ultrasound probe on the patient flank in prone position was used to identify the preselected target calyx. Needle was advanced through needle holder and fluoroscopy was used to document the entered calyx, site and angle of entry.Results:Successful entering to the target calyx was achieved in 43 cases (91%). Successful entry with appropriate entry site and angle was observed in 34 cases (72%). Reasons for failure were minimal hydronephrosis, upper pole access and high lying kidneys.Conclusions:Although it is feasible to access a preselected calyx by ultrasonography guidance during PCNL, but entry to the calyx from the appropriate site and direction is another problem and needs more experience. In cases of minimal hydronephrosis, superior pole access or high lying kidneys, ultrasonography is less successful and should be used with care.
Highlights
Percutaneous nephrolithotomy (PCNL) is the treatment of choice for surgical management of large renal stones
A perfect percutaneous access tract to the pelvicalyceal system should be made through the tip of renal papilla in the targeted calyx and to be along the axis of renal calyx [10] so that the guide wire is passed into the pelvis and/or ureter
Radio-opaque contrast was injected through ureteral catheter and after opacifying the pelvicalyceal system, needle path and guide wire route were documented by fluoroscopy (Figure-2)
Summary
Percutaneous nephrolithotomy (PCNL) is the treatment of choice for surgical management of large renal stones. It has previously been shown that ultrasonography guided PCNL is equivalent to or even sometimes better than fluoroscopy guided PCNL in terms of stone free rate [1, 5, 9], operation duration [5], bleeding [5, 9] and complications [5]. A perfect percutaneous access tract to the pelvicalyceal system should be made through the tip of renal papilla in the targeted calyx and to be along the axis of renal calyx [10] so that the guide wire is passed into the pelvis and/or ureter. In fluoroscopy guided PCNL, entry to the targeted calyx ibju | Ultrasound - guided access in PCNL is evident by 2 directional fluoroscopy images. We could not find any publication evaluating the precision of ultrasonography in targeting the desired calyx in the desired direction and through renal papillae
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
