Learning objectives
We review the indications for and contraindications to percutaneous nephrolithotripsy (PNL)
We discuss the importance of multimodality imaging in planning the operative approach
We review the necessary patient preparation,
positioning and access site planning using fluoroscopy and ultrasound prior to PNL
We describe standard percutaneous access techniques and discuss more advanced techniques employed in complex cases of urolithiasis such as combined calyceal and ureteral calculi,
calyceal diverticula and renal anatomical variants such as horseshoe kidneys,
duplex collecting systems and uretero-pelvic junction obstruction
We discuss post-procedure...
Background
Urolithiasis is a commonly encountered clinical problem,
accounting for 7-10 hospital admissions per 1000 in the United States with similar figures reported for the United Kingdom. The main aim of treatment is complete stone clearance however the evolution and refinement of minimally invasive techniques has revolutionized the treatment of urinary tract calculi over the last three decades. The technique of Percutaneous Nephrolithotripsy (PNL) was first described in 1976 by Fernstrom and Johansson [1]. The technique has subsequently been refined,
rendering it an effective and safe...
Imaging findings OR Procedure details
Multimodality Imaging:
ABDOMINAL RADIOGRAPHS
majority of urinary tract calculi are calcium-containing and should therefore be visible on plain radiographs
bowel gas,
faecal material in overlying colon,
patient obesity and extra-renal calcifications limit detection
overall low sensitivity in recent studies for detection of calculi,
ranging from 45-58% [15]
Nonetheless,
plain radiographs retain a central role in monitoring known radiopaque calculi and in planning fluoroscopically-guided therapeutic procedures such as PNL and ESWL
ABDOMINAL CT
Over 99% of stones will be visualized on non-contrast stone protocol CT (CT...
Conclusion
Since the opening of a dedicated the Stone Centre at Vancouver General Hospital,
significant improvements in rates of major complications,
including transfusion rates and pulmonary complications as well as improvements in stone free status have been achieved
Percutaneous Nephrolithotripsy is a safe and effective treatment for large calculi and those refractory to other treatment modalities
A co-operative,
integrated relationship between the radiologist and urologist optimizes patient care and stone-free rates
Complications can be minimized by strict adherence to basic anatomic priciples
Recommended in the Guidelines...
References
Fernstrom I,
Johansson B.
Percutaneous pyelolithotomy.
A new extraction technique.
Scand J Urol Nephrol 1976;10:257-259
Tiselius HG,
Alken P,
Buck C,
Gallucci M,
Knoll T,
Sarica K,
Turk C. Guidelines on urolithiasis.
European Urological Association,
2008
Preminger GM,
Assimos DG,
Lingeman JE,
Nakada SY,
Pearle MS,
Wolf JS Jr.
AUA Nephrolithiasis Guideline Panel.
Chapter 1: AUA guideline on management of staghorn calculi: Diagnosis and Treatment Recommendations.
J Urol 2005; 173:1991-2000
Al-Kohlany KM,
Shokeir AA,
Mosbah A,
Mohsen T,
Shoma AM,
Eraky I,
El-Kenawy M,
El-Keppany...