Ultrasound - guided access during percutaneous nephrolithotomy: entering desired calyx with appropriate entry site and angle

Abstract

Objectives: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.

Safety of Upper Pole Puncture in Percutaneous Nephrolithotomy with the Guidance of Ultrasonography versus Fluoroscopy: A Comparative Study

“…It was expected that the UG group would have a lower radiation exposure time; in accordance with our findings, in other studies, the radiation exposure time has been reported to be quite limited in UG access, which is a major advantage for both healthcare providers and patients [17, 26]. Gaining UPA with UG can be challenging in patients with minimal hydronephrosis, but saline injection from the ureteral catheter can resolve this problem [27].…”

Comparison of Middle and Lower Calyceal Access for Renal Pelvis Stone in Percutaneous Nephrolithotomy: A Prospective Randomized Study

“…Percutaneous removal of larger stones sizing >20 mm became the preferred treatment alternative for the minimal invasive management such as calculi with reported stonefree rates of >90% [3,5,9]. Related with the puncturing and entering to the renal collecting system, although fluoroscopic guidance has been used in a commonly accepted manner in all parts of the world, increasing experience in sonographic applications has enabled the endourologists to puncture the collecting system under sonographic guidance (either with free hand or by using specific attachment systems) in a practical and effective way [10][11][12]. Puncturing the kidney with this technique seems to have some cer- tain advantages among which the quick identification of the desired calyx with limited radiation exposure is the most important factor to be mentioned [13,14].…”

Application of Three-dimensional Visualization assisted Ultrasound for Percutaneous Renal Puncture

“…6 In clinical practice, ensuring that the percutaneous renal puncture is routed precisely through the axis of the targeted renal calyx is di cult. 7 It requires an accurate location of the central axis of the 3D conical renal calyx and precise, simultaneous navigation in three dimensions (X, Y, Z). At present, the commonly used 2D guidance methods (i.e., plain radiography, B-US) cannot accurately locate the skin puncture point or route, [8][9][10] which is the most signi cant technical obstruction to using percutaneous renal puncture.…”