Complex PCNL and Antegrade Endopyelotomy

Abstract

As most routine calculi can be treated by FURS and ESWL most stones presenting for PCNL are complex.

These include partial or complete infection related staghorn calculi, dense cystine stones, calyceal diverticular calculi, stones in the neurogenic bladder and spinal cord patients or urinary diversions, or anatomically different kidneys such as a horseshoe kidney.

These cases can be complex due pyonephrosis, lack of a collecting system space, spatial disposition, body wall abnormalities or impactions in the renal substance or the upper ureter.

This chapter discusses difficult access including techniques such as alternating J-wire technique, the retroperitoneal guidewire, elective “Y” puncture, puncture of a large hydronephrosis using air contrast, multi tract PCNL, antegrade uretero lithotomy and antegrade percutaneous endopyelotomy.