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Prone Percutaneous Access: Case Discussion—Caliceal Diverticular Calculi

  • John D. DenstedtEmail author
  • Andrew Fuller
Chapter

Abstract

Since its initial description by Fernstrom and Johansson in 1976, percutaneous nephrolithotomy (PCNL) has evolved with improvements in technique and equipment to become the gold standard form of management for large stones in the upper urinary tract. It has now largely replaced open surgery in this context. Although alternatives such as supine patient positioning have emerged in the last decade, the vast majority of PCNL cases worldwide continue to be performed prone, with high stone-free rates (SFR) and a low incidence of major complications (Duvdevani et al., J Endourol, 21:824–9, 2007; de la Rosette et al., J Endourol, 25:11–7, 2011).

The ability to safely and efficiently achieve percutaneous renal access depends on a number of factors including appropriate training, careful preoperative planning, recognition of anatomical variation, interpretation of radiological investigations, reproducible technique, and the availability of specialized instrumentation to effectively delineate and negotiate the urinary tract. Tract placement by the treating urologist without the involvement of an interventional radiologist in routine cases has been shown to be associated with excellent outcomes (Tomaszewski et al., J Endourol, 24:1733–7, 2010; El-Assmy et al., J Urol, 178:916–20, 2007; Watterson et al., J Urol, 176:142–5, 2006). Additionally, such an approach allows PCNL to be performed as a one-stage procedure with the opportunity to place additional tracts as dictated by intraoperative findings.

This chapter summarizes what we believe to be a series of safe and effective strategies when performing percutaneous renal access. In presenting the chapter, we acknowledge that there are many effective alternate approaches to PCNL, some of which may not have been incorporated into this work. Many cases require the endourologist to safely apply a range of techniques in combination to achieve the desired outcome.

Keywords

Renal Pelvis Shock Wave Lithotripsy Extracorporeal Shock Wave Lithotripsy Stone Removal Ureteral Catheter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

CD

Caliceal diverticulum

CT

Computed tomography

PCNL

Percutaneous nephrolithotomy

SFR

Stone-free rate

SWL

Shock wave lithotripsy

TDPN

Transdiverticular puncture and neoinfundibulotomy

UPJ

Ureteropelvic junction

URS

Ureteroscopy

US

Ultrasound

UTI

Urinary tract infection

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of SurgeryWestern UniversityLondonCanada
  2. 2.Division of Urology, Department of SurgeryWestern UniversityLondonCanada

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