Percutaneous nephrolithotomy: implementation of digital insertion and dissection as an adjunct to the technique

Autores/as

  • Jose Rodrigo Arellano-Cuadros Hospital Juárez de México
  • Javier Pineda-Murillo Hospital Juárez de México
  • Jesus Torres-Aguilar Hospital Juárez de México
  • Ana Fatima Sandoval-Salazar Hospital Juárez de México

DOI:

https://doi.org/10.48193/revistamexicanadeurologa.v78i3.79

Resumen

BACKGROUND: Percutaneous nephrolithotomy (PCNL) was established as a minimally invasive treatment option for kidney stones in the 1970s and is considered a safe and effective procedure, with stone clearance rates of 78-95%. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free status and minimize the risk of complications. 

CLINICAL CASE: We present the case of a 36-year-old male patient with bilateral lower back pain. A CT urography scan was performed that revealed bilateral lithiasis. The stone on the right side was consistent with an incomplete staghorn stone and a right retrorenal colon was identified. Left flexible nephrolithotripsy and subsequent right percutaneous nephrolithotomy were performed. A puncture was made under fluoroscopic guidance supported by previous digital dissection of all layers of the abdominal wall until gaining access to the retroperitoneum. Colonic lesion was prevented and a tunnel through which the renal unit could be palpated was formed. 

CONCLUSIONS: The technique of digital insertion and dissection offers safe access to the renal unit that is useful in patients presenting with risk factors for a potential complication. 

KEYWORDS: Digital; Kidney; Lithiasis; Percutaneous nephrolithotomy.

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Publicado

2018-06-26

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