Retrograde nephrostomy access for percutaneous nephrolithotomy: a simple and safe technique

  • Khalid M. AlotaibiEmail author
Original Paper


This study aimed at illustrating our experience with the retrograde nephrostomy access technique for percutaneous nephrolithotomy (PCNL).This retrospective study was conducted between June 1997 and September 2018 for 648 patients who underwent PCNL with retrograde nephrostomy access. Included in the study were the patient demographic, operative time, site of the access, fluoroscopic exposure time, stone clearance rate, additional procedures and complications. A total of 648 patients aged between 25 and 70 years had renal stones and were included in this study. Retrograde nephrostomy access was achieved through the upper calyx in 252 patients (38.9%), middle calyx in 348 patients (53.7%) and lower calyx in 48 patients (7.4%). Among those patients, 108 (16.7%) required supracostal access. The average time for the retrograde access and PCNL was 14.4 min and 40 min, respectively. The average fluoroscopic exposure time for the retrograde access was 3.2 min. There were 12 failures (1.9%) as a result of severe hydronephrosis. Complete stone clearance was achieved in 91.8%. Small stone fragments (4 mm or less) were detected in 7.4%. Median hospital stay was 3.5 days (range 3–7). Complications occurred in 39 patients (6%). Eight patients (1.2%) developed significant postoperative hemorrhage that was controlled by transfusion and angioembolization. There were no recorded cases of colonic injuries, pneumothorax or hemothorax, demonstrating that the retrograde access technique is safe and reliable. It provides control over both ends of the wire eliminating the risk of accidental wire displacement. Radiation exposure is minimal. There are low failure and complication rates.


Nephrostomy Retrograde access Percutaneous nephrolithotomy Kidney calculi Percutaneous kidney access 



Computerized tomography


Interventional radiologist


Percutaneous nephrolithotomy


Stone-free rate


Shock wave lithotripsy


Compliance with ethical standards

Conflict of interest

The author has no conflict of interest to declare. The study received no financial support. All data are available for review upon request. As this was a retrospective study, consent was not obtained. This study has been approved by the Imam Abdulrahman bin Faisal University ethics committee. The author designed the study, acquired and analyzed the data and wrote the manuscript.

Supplementary material

Video: Short Video for Retrograde access technique (MP4 21,487 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Imam Abdulrahman Bin Faisal UniversityKhobarSaudi Arabia

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