A Review and Illustration of Contemporary Percutaneous Nephrolithotomy Practice Using Intracorporeal Techniques through Single Punctures for Complex Stone Burden in a UK Tertiary Referral Centre

Abstract

Objective: The treatment of complex renal stones remains challenging for surgeons using percutaneous nephrolithotomy (PCNL). A number of contemporary accessory techniques can help improve stone clearance allowing a reduction of multiple punctures and morbidity. We report our experience using a single puncture for complex stone cases. Patients and methods: We reviewed the practice of single puncture for complex stones (partial staghorns involving multiple calyces and complete staghorns) in our Institute from 2004 to 2007. These cases included paediatric patients who would otherwise typically endure open nephrolithotomy. Stone clearance, by intra-operative renoscopy and post-operative KUB, and requirement for ancillary procedures was assessed. Results: In total 35 complex stone cases were identified that matched the inclusion criteria (4 children). All patients were treated with a solitary puncture and two cases were abandoned due to excessive bleeding at the time of percutaneous access. Of the 33/35 cases that progressed fluoroscopic stone clearance was achieved. Case-based illustrations are presented showing accessory techniques such as intracorporeal catheters, flexible cystoscopy, basketing, lasering and percutaneous needle manipulations that facilitated these results. Conclusions: In cases of complex renal stone disease, the use of contemporary PCNL techniques can allow significant stone clearance through a single puncture in most cases. A team approach with intervention radiologists is emphasized.