Percutaneous nephrolithotomy (PCNL) is considered the treatment of choice for large urinary calculi and staghorn lithiasis. Several techniques have been described for the initial puncture and access. Herein we describe the technique used at our center for fluoroscopy-guided prone percutaneous puncture, which we call the ‘needle kiss; technique.
In the following video, we presented a practical example of our technique step by step, in a case of posterior lower calyx puncture.
The procedure was performed with the patient under general anesthesia, and a 6Fr ureteral open-end catheter was advanced into the renal pelvis for contrast installation in the lithotomy position. Afterwards, the patient was placed in prone position. Retrograde pyelogram through the catheter showed imaging of the upper urinary tract and calyceal anatomy.
Once we identified the target calyx for percutaneous access, a first needle (20G) was perpendicularly (90°) punctured through the skin, and a correct puncture was confirmed if the urine came out from the needle. This first puncture was crucial to determine the deepness of the calyx in relation with the skin. Next, with a larger 18G needle we accomplished the second puncture, this was the access tract. Under fluoroscopy guidance, we advanced the needle in the angulation and deepness needed to puncture through the calyceal-papilla-infundibulum axis. The main goal of our technique was to join both needle tips.
The inclination of the second needle (18G) puncture was guided by the deepness of the first needle (20G), a superficial puncture with the first needle would indicate a more superficial calyx and vice-versa.
We strictly recommend the use of radiation protective gloves and minimizing the time of fluoroscopy exposure as much as possible.
After using this technique for prone percutaneous puncture at our center for several years, we can conclude that it is safe, feasible, and provides quick percutaneous access without the use of ultrasound.
CONFLICTS OF INTEREST
The authors declare no conflicts of interest.
Video can be found at http://www.ceju.online/journal/2019/fluoroscopy-percutanoeus-nephrolithotomy-puncture-renal-lithiasis-1952.php
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Supplementary Materials
Video can be found at http://www.ceju.online/journal/2019/fluoroscopy-percutanoeus-nephrolithotomy-puncture-renal-lithiasis-1952.php