Combined Percutaneous And Retrograde Approach To Staghorn Calculi With Application Of The Ureteral Access Sheath To Facilitate Percutaneous Nephrolithotomy

Abstract

Our preliminary clinical experience using the ureteral access sheath during percutaneous nephrolithotomy for simultaneous antegrade and retrograde stone treatment has been favorable. A large renal stone burden can be successfully managed with a single percutaneous access and limited blood loss.

Pathophysiology and Management of Infectious Staghorn Calculi

“…Five of seven patients were stone-free 3 months postoperatively, with two patients demonstrating asymptomatic residual fragments measuring less than 3 mm in their longest dimension. Similarly, Landman and colleagues [29] treated nine staghorn calculi (six complete, six partial) with combined flexible ureteroscopy and PCNL via a single lower-pole access. In contrast to the technique used by Marguet, patients were prone for the entire procedure and retrograde flexible ureteroscopy and antegrade PCNL were performed simultaneously.…”

Endoscopy-Guided Percutaneous Nephrostolithotomy: Benefits of Ureteroscopic Access and Therapy

“…Thus upper-pole calices can be cleared of stone burden before the creation of the percutaneous tract, the entire collecting system can be surveyed, and calculi in peripheral calices, which would potentially need a second access tract, are accessed and treated. 40,41 The use of an ureteral access sheath facilitates the extraction of stone fragments and helps reduce intrapelvic pressure while maintaining irrigation flow. 22,42 Retrograde irrigation may further facilitate needle access by dilating the targeted collecting system.…”

Treatment of the Infected Stone

“…59 PCNL and ureteroscopy may be performed simultaneously in the prone position with a split leg bed, avoiding time needed to reposition from dorsal lithotomy to prone. 60,61 Combination therapy for the treatment of infection stones refers to the use of PCNL with shockwave lithotripsy (SWL). Segura and colleagues 62 reported a disappointing stone free rate of 23% in their series of 16 consecutive patients undergoing PCNL followed by SWL.…”