You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2012V1719 FLEXIBLE URETEROSCOPY-ASSISTED RETROGRADE NEPHROSTOMY FOR PCNL Jason B. Wynberg, Joshua Z. Vicena, Scott A. Salmon, and Vince N. Hannosh Jason B. WynbergJason B. Wynberg Detroit, MI More articles by this author , Joshua Z. VicenaJoshua Z. Vicena Detroit, MI More articles by this author , Scott A. SalmonScott A. Salmon Detroit, MI More articles by this author , and Vince N. HannoshVince N. Hannosh Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1678AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We adapted the COOK® Lawson retrograde nephrostomy puncture wire for deployment through the operating channel of a flexible ureteroscope. We present our initial experience with this technique. METHODS Patients were placed under general anesthesia and positioned in Galdakao-Modified Supine Valdivia position. Previously placed ureteric stent was removed and flexible ureteroscopy was performed with ureteral access sheath and safety wire in place. Flexible ureteroscope was advanced into selected calyx and trajectory for puncture wire deployment was evaluated with 2-plane fluoroscopy. Laser was applied to stone if needed to enter selected calyx. Surgeon held ureteroscope position while assistant passed puncture wire into working channel until tip emerged from scope. Assistant then released pin-vise lock and advanced puncture wire in 1 cm increments under fluoroscopic guidance until wire emerged from flank. A 5F, 30 cm coaxial transitional dilating catheter (Vascular Solutions, Inc.) was used as an exchange catheter at the flank and advanced over puncture wire into ureter. Puncture wire, inner catheter from coaxial set and ureteroscope were removed. A 0.038” wire was advanced antegrade through outer catheter of coaxial set until wire emerged out of ureteric access sheath. Outer coaxial was then removed from flank, 0.038” wire was secured at flank and urethra. 5F catheter was advanced into ureter for retrograde imaging during PCNL prior to removing access sheath. Foley catheter was placed in the bladder. PCNL was then performed in same position. RESULTS Procedure was successful in 8/9 patients – in one patient, puncture wire tract was not dilated due to high kidney, nearby pleura. Mean BMI - 31.5; mean stone diameter 2.5 x 1.7 cm, and mean 1.3 stones per kidney. Only one access was performed in all patients with mean 2.3 wire passages to achieve acceptable wire passage. Laser lithotripsy was required in one case to grant access to selected calyx. All dilated punctures were behind the posterior axillary line. For nephrostomy + PCNL: procedure - mean 153 min., fluoro - mean 2 min. 48 s. Five patients were stone free; two required subsequent ureteroscopy. No complications were noted in this series. CONCLUSIONS This technique is safe, intuitive, and builds on modern urologists' endoscopy skills. We found it easy to teach to residents. Careful pre-op review of adjacent organs on CT scan to establish a safe course for wire passage is critical for establishing patient eligibility. We found this procedure more difficult in obese patients. We contemplate a complementary role for this technique alongside antegrade methods. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e693 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jason B. Wynberg Detroit, MI More articles by this author Joshua Z. Vicena Detroit, MI More articles by this author Scott A. Salmon Detroit, MI More articles by this author Vince N. Hannosh Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...