A Novel method of ensuring safe and accurate dilatation during percutaneous nephrolithotomy

Abstract

Objective:To report our technique that helps locate the guidewire into the ureter enabling safe dilatation during PCNL.Materials and Methods:Cases in which the guidewire failed to pass into the ureter following successful puncture of the desired calyx were subjected to this technique. A second guidewire was passed through the outer sheath of a 9 Fr. metallic dilator cannula, passed over the first guidewire. The cannula and outer sheath were removed, followed by percutaneous passage of a 6/7.5 Fr ureteroscope between the two guidewires, monitoring its progress through both the endoscopic and fluoroscopic monitors. Once the stone was visualized in the calyx a guidewire was passed through the working channel and maneuvered past the stone into the pelvis and ureter under direct endoscopic vision. This was followed by routine tract dilatation.Results:This technique was employed in 85 out of 675 cases of PCNL carried out at our institute between Jan 2010 to June 2014. The mean time required for our technique, calculated from the point of introduction of the ureteroscope untill the successful passage of the guidewire down into the ureter was 95 seconds. There were no intraoperative or postoperative complications as a result of this technique. Guidewire could be successfully passed into the ureter in 82 out of 85 cases.Conclusions:Use of the ureteroscope introduced percutaneously through the puncture site in PCNL, is a safe and effective technique that helps in maneuvering the guidewire down into the ureter, which subsequently enables safe dilatation.

Percutaneous nephrolithotomy assisted by LithoClast master in one-phase treatment for staghorn renal stones with refractory infections

“…The creation of a nephrostomy channel is the key procedure for a successful PCNL [10,11]. The steps of channel establishment are mainly divided into puncture and dilation, which requires the surgeon to accurately puncture and rapidly dilate [12,13]. Generally, puncture is guided in vitro by X-ray or US [12,14].…”

Is it necessary to have a guidewire down through the ureter during mini percutaneous nephrolithotomy? Single‐centre experience with 1052 cases

“…In order to solve this problem, different solutions were suggested by the endourologists. Javali et al inserted a semirigid ureteroscope percutaneously before tract dilation to establish secure guidewire placement down through the ureter with endoscopic control 5 . Also, Cracco et al suggested possible use of retrograde flexible ureterorenoscopy to catch and pull the guidewire in order to maintain the through‐through access in supine position 6 .…”

Combined direct visual and imaging guided percutaneous renal access using on shot tract dilation, a case series of novel methods of tract dilatation

“…Revisions of this technique led to develop Amplatz dilator which could hold the ureteroscope inside and be used as a single shot dilator for percutaneous access. Feasibility of percutaneous access tract dilation especially in animal models is shown using a visual dilator system (10) guidance into the calyx (17). Semi-rigid ureteroscope was passed percutaneously during the puncture wound between the two guidewires, watching its secure progress using both the endoscopic and the fluoroscopic monitors, till the semi rigid ureteroscope go to the target calyx and the stone can be observed.…”

“…The rest of the process was then done in the usual manner. This method was done over 7 85 patients and in 82 of them the passing of guidewire in to the ureter was successful with mean time of duration equal to 95 seconds (from ureteroscope to ureter entrance) (17).…”