Percutaneous Access to the Kidney: Endoscopic

  • Adam Kaplan
  • Jaime LandmanEmail author


Proper access to the renal collecting system presents the greatest challenge for the urologist performing percutaneous nephrolithotomy for large renal stones. This chapter describes a technique for percutaneous renal access in which placement of a ureteral access sheath and ureteroscopy in the prone position provide direct visualization of percutaneous needle placement through the kidney. Nephrolithotomy tract dilation and sheath placement occur in a similar fashion to standard PCNL, but with the advantage of direct visualization. With this technique, precise renal access can be obtained with fewer renal punctures, optimized position of the access into a superior pole posterior calyx, decreased complication rates, and improved stone clearance.


Needle Puncture Stone Burden Tract Dilation Access Sheath Flexible Ureteroscope 
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.


  1. 1.
    Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. 1955;157(11):891–4.PubMedCrossRefGoogle Scholar
  2. 2.
    Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10(3):257–9.PubMedGoogle Scholar
  3. 3.
    Morris DS, Wei JT, Taub DA, Dunn RL, Wolf Jr JS, Hollenbeck BK. Temporal trends in the use of percutaneous nephrostolithotomy. J Urol. 2006;175(5):1731–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Skolarikos A, Alivizatos G, de la Rosette JJ. Percutaneous nephrostolithotomy and its legacy. Eur Urol. 2005;47(1):22–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Hunter PT, Hawkins IF, Finlayson B, Nanni G, Senior D. Hawkins-Hunter retrograde transcutaneous nephrostomy: a new technique. Urology. 1983;22(6):583–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Lawson RK, Murphy JB, Taylor AJ, Jacobs SC. Retrograde method for percutaneous access to kidney. Urology. 1983;22(6):580–2.PubMedCrossRefGoogle Scholar
  7. 7.
    Hawkins Jr IF. Retrograde percutaneous nephrostomy. Crit Rev Diagn Imaging. 1987;27(2):153–65.PubMedGoogle Scholar
  8. 8.
    Spirnak JP, Resnick MI. Retrograde percutaneous stone removal using modified Lawson technique. Urology. 1987;30(6):551–3.PubMedCrossRefGoogle Scholar
  9. 9.
    Morrisseau PM, Trotter SJ. Retrograde percutaneous nephrolithotomy: urological treatment of a urological problem. J Urol. 1988;139(6):1163–5.PubMedGoogle Scholar
  10. 10.
    Leal JJ. Percutaneous removal of renal and ureteral stones with and without concomitant transurethral manipulation by a urologist using antegrade and retrograde techniques without a radiologist’s assistance. J Urol. 1988;139(6):1184–7.PubMedGoogle Scholar
  11. 11.
    Munch LC. Direct vision modified Lawson retrograde nephrostomy technique using flexible ureteroscope. J Endourol. 1989;3:411–7.CrossRefGoogle Scholar
  12. 12.
    Grasso M, Bagley D. Small diameter, actively deflectable, flexible ureteropyeloscopy. J Urol. 1998;160(5):1648–53. discussion 1653–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Traxer O. Flexible ureterorenoscopic management of lower pole stone: does the scope make the difference? J Endourol. 2008;22(9):1847–50. discussion 1855.PubMedCrossRefGoogle Scholar
  14. 14.
    Afane JS, Olweny EO, Bercowsky E, Sundaram CP, Dunn MD, Shalhav AL, McDougall EM, Clayman RV. Flexible ureteroscopes: a single center evaluation of the durability and function of the new endoscopes smaller than 9 Fr. J Urol. 2000;164(4):1164–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Landman J, Venkatesh R, Lee DI, Rehman J, Ragab M, Darcy M, Sundaram CP. Combined percutaneous and retrograde approach to staghorn calculi with application of the ureteral access sheath to facilitate percutaneous nephrostolithotomy. J Urol. 2003; 169(1):64–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Delvecchio FC, Auge BK, Brizuela RM, Weizer AZ, Silverstein AD, Lallas CD, Pietrow PK, Albala DM, Preminger GM. Assessment of stricture formation with the ureteral access sheath. Urology. 2003;61(3):518–22.PubMedCrossRefGoogle Scholar
  17. 17.
    Monga M, Best S, Venkatesh R, Ames C, Lieber D, Vanlangendock R, Landman J. Prospective randomized comparison of 2 ureteral access sheaths during flexible retrograde ureteroscopy. J Urol. 2004;172(2):572–3.PubMedCrossRefGoogle Scholar
  18. 18.
    Rehman J, Monga M, Landman J, Lee DI, Felfela T, Conradie MC, Srinivas R, Sundaram CP, Clayman RV. Characterization of intrapelvic pressure during ureteropyeloscopy with ureteral access sheaths. Urology. 2003;61(4):713–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Auge BK, Pietrow PK, Lallas CD, Raj GV, Santa-Cruz RW, Preminger GM. Ureteral access sheath provides protection against elevated renal pressures during routine flexible ureteroscopic stone manipulation. J Endourol. 2004;18(1):33–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Grasso M, Lang G, Taylor FC. Flexible ureteroscopically assisted percutaneous renal access. Tech Urol. 1995;1(1):39–3.PubMedGoogle Scholar
  21. 21.
    Kidd CF, Conlin MJ. Ureteroscopically assisted percutaneous renal access. Urology. 2003;61(6):1244–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Khan F, Borin JF, Pearle MS, McDougall EM, Clayman RV. Endoscopically guided percutaneous renal access: “Seeing is believing”. J Endourol. 2006;20(7):451–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Sountoulides PG, Kaufmann OG, Louie MK, Beck S, Jain N, Kaplan A, McDougall EM, Clayman RV. Endoscopy-guided percutaneous nephrostolithotomy: benefits of ureteroscopic access and therapy. J Endourol. 2009;23(10):1649–54.PubMedCrossRefGoogle Scholar
  24. 24.
    Lingeman JE, Matlaga BR, Evan AP. Surgical management of upper urinary tract calculi. In: Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Campbell-Walsh urology. 9th ed. Philadelphia: Saunders Elsevier; 2007. p. 1431–507.Google Scholar
  25. 25.
    Watterson JD, Soon S, Jana K. Access related complications during percutaneous nephrostolithotomy: urology versus radiology at a single academic institution. J Urol. 2006;176(1):142–5.PubMedCrossRefGoogle Scholar
  26. 26.
    de la Rosette JJMCH, Laguna MP, Rassweiler JJ, Conort P. Training in percutaneous nephrostolithotomy—a critical review. Eur Urol. 2008;54(5):994–1001.PubMedCrossRefGoogle Scholar
  27. 27.
    Tanriverdi O, Boylu U, Kendirci M, Kadihasanoglu M, Horasanli K, Miroglu C. The learning curve in the training of percutaneous nephrostolithotomy. Eur Urol. 2007;52(1):206–11.PubMedCrossRefGoogle Scholar
  28. 28.
    Ankem MK, Lowry PS, Slovick RW, del Rio Munoz A, Nakada SY. Clinical utility of dual active deflection flexible ureteroscope during upper tract ureteropyeloscopy. Urology. 2004;64(3):430–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of UrologyUniversity of California, Irvine Medical CenterOrangeUSA

Personalised recommendations