Summary
Percutaneous nephrolithotomy (PNL) remains an important part of the urologist’s armamentarium. Although PNL can be used to treat upper tract calculi of any size, it is particularly effective for treating patients with complex stone disease or coexisting renal pathology such as ureteropelvic junction obstruction or stone-containing calyceal diverticula (CD). Since its introduction in the late 1970s, PNL has undergone a considerable evolution in technique. However, the performance of PNL is entirely dependent on achieving satisfactory access.This chapter reviews the current access techniques for percutaneous renal surgery.
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References
Fernstrom I, Johansson B (1976) Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol 10:257–259
Motola JA, Smith AD (1990) Therapeutic options for the management of upper tract calculi. Urol Clin N Am 17:191–206
Lam HS, Lingeman JE, Mosbaugh PG, Steele RE, Knapp PM, Scott JW, Newman DM (1992) Evolution of the technique of combination therapy for staghorn calculi: a decreasing role for extracorporeal shock wave lithotripsy. J Urol 148:1058–1062
Lingeman JE, Coury TA, Newman DM, Kahnoski RJ, Mertz JH, Mosbaugh PG, Steele RE, Woods JR (1987) Comparison of results and morbidity of percutaneous nephrostolithotomy and extracorporeal shock wave lithotripsy. J Urol 138:485–490
Grasso M, Conlin M, Bagley D (1998) Retrograde ureteropyeloscopic treatment of 2 cm or greater upper urinary tract and minor staghorn calculi. J Urol 160:346–351
Consensus Conference (1988) Prevention and treatment of kidney stones. JAMA 260:977–981
Meretyk S, Gofrit ON, Gafni O, Pode D, Shapiro A, Verstandig A, Sasson T, Katz G, Landau EH (1997) Complete staghorn calculi: random prospective comparison between extracorporeal shock wave lithotripsy monotherapy and combined with percutaneous nephrostolithotomy. J Urol 157:780–786
Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr (2005) Chapter 1:AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol 173:1991–2000
Albala DM, Assimos DG, Clayman RV, Denstedt JD, Grasso M, Gutierrez-Aceves J, Kahn RI, Leveillee RJ, Lingeman JE, Macaluso JN Jr, Munch LC, Nakada SY, Newman RC, Pearle MS, Preminger GM, Teichman J, Woods JR (2001) Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol 166:2072–2080
Kuo RL, Lingeman JE, Leveillee RJ, Pearle MS, Watkins S, Fineberg NS, Group LPS (2003) Lower Pole II: initial results from a comparison of shock wave lithotripsy (SWL), ureteroscopy (URS), and percutaneous nephrostolithotomy (PNL) for lower pole nephrolithiasis. J Urol 169:1821A
Chow GK, Streem SB (1998) Contemporary urological intervention for cystinuric patients: immediate and long-term impact and implications. J Urol 160:341–344; discussion 344-345
Klee LW, Brito CG, Lingeman JE (1991) The clinical implications of brushite calculi. J Urol 145:715–718
Margel D, Ehrlich Y, Brown N, Lask D, Livne PM, Lifshitz DA (2006) Clinical implication of routine stone culture in percutaneous nephrolithotomy-a prospective study. Urology 67:26–29
Mariappan P, Smith G, Bariol SV, Moussa SA, Tolley DA (2005) Stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy: a prospective clinical study. J Urol 173:1610–1614
McAleer IM, Kaplan GW, Bradley JS, Carroll SF (2002) Staghorn calculus endotoxin expression in sepsis. Urology 59:601
McAleer IM, Kaplan GW, Bradley JS, Carroll SF, Griffith DP (2003) Endotoxin content in renal calculi. J Urol 169:1813–1814
Paterson RF, Kuo RL, Lingeman JE (2003) Staghorn calculus endotoxin expression in sepsis. Urology 62:197; author reply 197–198
Williams G, Blandy JP, Tresidder GC (1969) Communicating cysts and diverticula of the renal pelvis. Br J Urol 41:163–170
Yow RM, Bunts RC (1955) Calyceal diverticulum. J Urol 73:663–670
Wulfsohn MA (1980) Pyelocaliceal diverticula. J Urol 123:1–8
Auge BK, Munver R, Kourambas J, Newman GE, Preminger GM (2002) Endoscopic management of symptomatic caliceal diverticula: a retrospective comparison of percutaneous nephrolithotripsy and ureteroscopy. J Endourol 16:557–563
Batter SJ, Dretler SP (1997) Ureterorenoscopic approach to the symptomatic caliceal diverticulum. J Urol 158:709–713
Grasso M, Lang G, Loisides P, Bagley D, Taylor F (1995) Endoscopic management of the symptomatic caliceal diverticular calculus. J Urol 153:1878–1881
Miller SD, Ng CS, Streem SB, Gill IS (2002) Laparoscopic management of caliceal diverticular calculi. J Urol 167:1248–1252
Ruckle HC, Segura JW (1994) Laparoscopic treatment of a stone-filled, caliceal diverticulum: a definitive, minimally invasive therapeutic option. J Urol 151:122–124
Auge BK, Munver R, Kourambas J, Newman GE, Wu NZ, Preminger GM (2002) Neoinfundibulotomy for the management of symptomatic caliceal diverticula. J Urol 167:1616–1620
Hulbert JC, Reddy PK, Hunter DW, Castaneda-Zuniga W, Amplatz K, Lange PH (1986) Percutaneous techniques for the management of caliceal diverticula containing calculi. J Urol 135:225–227
Jones JA, Lingeman JE, Steidle CP (1991) The roles of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy in the management of pyelocaliceal diverticula. J Urol 146:724–727
Psihramis KE, Dretler SP (1987) Extracorporeal shock wave lithotripsy of caliceal diverticula calculi. J Urol 138:707–711
Bellman GC, Silverstein JI, Blickensderfer S, Smith AD (1993) Technique and follow-up of percutaneous management of caliceal diverticula. Urology 42:21–25
Monga M, Smith R, Ferral H, Thomas R (2000) Percutaneous ablation of caliceal diverticulum: long-term followup. J Urol 163:28–32
Shalhav AL, Soble JJ, Nakada SY, Wolf JS Jr, McClennan BL, Clayman RV (1998) Long-term outcome of caliceal diverticula following percutaneous endosurgical management.J Urol 160:1635–1639
Canales B, Monga M (2003) Surgical management of the calyceal diverticulum. Curr Opin Urol 13:255–260
Husmann DA, Milliner DS, Segura JW (1996) Ureteropelvic junction obstruction with concurrent renal pelvic calculi in the pediatric patient: a long-term followup. J Urol 156:741–743
Matin SF, Streem SB (2000) Metabolic risk factors in patients with ureteropelvic junction obstruction and renal calculi. J Urol 163:1676–1678
Ramakumar S, Lancini V, Chan DY, Parsons JK, Kavoussi LR, Jarrett TW (2002) Laparoscopic pyeloplasty with concomitant pyelolithotomy. J Urol 167:1378–1380
Goldfischer ER, Jabbour ME, Stravodimos KG, Klima WJ, Smith AD (1998) Techniques of endopyelotomy. Br J Urol 82:1–7
Evans WP, Resnick MI (1981) Horseshoe kidney and urolithiasis. J Urol 125:620–621
Pitts WR Jr, Muecke EC (1975) Horseshoe kidneys: a 40-year experience. J Urol 113:743–746
Weizer AZ, Springhart WP, Ekeruo WO, Matlaga BR, Tan YH, Assimos DG, Preminger GM (2005) Ureteroscopic management of renal calculi in anomalous kidneys. Urology 65:265–269
Esuvaranathan K, Tan EC, Tung KH, Foo KT (1991) Stones in horseshoe kidneys: results of treatment by extracorporeal shock wave lithotripsy and endourology. J Urol 146:1213–1215
Kirkali Z, Esen AA, Mungan MU (1996) Effectiveness of extracorporeal shockwave lithotripsy in the management of stone-bearing horseshoe kidneys. J Endourol 10:13–15
Kupeli B, Isen K, Biri H, Sinik Z, Alkibay T, Karaoglan U, Bozkirli I (1999) Extracorporeal shockwave lithotripsy in anomalous kidneys. J Endourol 13:349–352
Lampel A, Hohenfellner M, Schultz-Lampel D, Lazica M, Bohnen K, Thurof JW (1996) Urolithiasis in horseshoe kidneys: therapeutic management. Urology 47:182–186
Theiss M, Wirth MP, Frohmuller HG (1993) Extracorporeal shock wave lithotripsy in patients with renal malformations. Br J Urol 72:534–538
Al-Otaibi K, Hosking DH (1999) Percutaneous stone removal in horseshoe kidneys. J Urol 162:674–677
Jones DJ, Wickham JE, Kellett MJ (1991) Percutaneous nephrolithotomy for calculi in horseshoe kidneys. J Urol 145:481–483
Raj GV, Auge BK, Weizer AZ, Denstedt JD, Watterson JD, Beiko DT, Assimos DG, Preminger GM (2003) Percutaneous management of calculi within horseshoe kidneys. J Urol 170:48–51
Rigatti P, Montorsi F, Guazzoni G, di Girolamo V, Consonni P, Colombo R, Da Pozzo L, Bocciardi A (1991) Multimodal therapy for stones in pelvic kidneys. Urol Int 46:29–34
Eshghi AM, Roth JS, Smith AD (1985) Percutaneous transperitoneal approach to a pelvic kidney for endourological removal of staghorn calculus. J Urol 134: 525–527
Figge M (1988) Percutaneous transperitoneal nephrolithotomy. Eur Urol 14:414–416
Kim SC, Kuo RL, Paterson RF, JE L (2003) Laparoscopic assisted percutaneous nephrolithotomy: best done tubeless? J Urol 169:79
Lee CK, Smith AD (1992) Percutaneous transperitoneal approach to the pelvic kidney for endourologic removal of calculus; three cases with two successes. J Endourol 6:133
Toth C, Holman E, Pasztor I, Khan AM (1993) Laparoscopically controlled and assisted percutaneous transperitoneal nephrolithotomy in a pelvic dystopic kidney. J Endourol 7:303–305
Zafar FS, Lingeman JE (1996) Value of laparoscopy in the management of calculi complicating renal malformations. J Endourol 10:379–383
Holman E, Toth C (1998) Laparoscopically assisted percutaneous transperitoneal nephrolithotomy in pelvic dystopic kidneys: experience in 15 successful cases. J Laparoendosc Adv Surg Tech A 8:431–435
Matlaga BR, Shah OD, Zagoria RJ, Dyer RB, Streem SB, Assimos DG (2003) Computerized tomography guided access for percutaneous nephrostolithotomy. J Urol 170:45–47
Wheatley M, Ohl DA, Sonda LP 3rd, Wang SC, Konnak JW (1991) Treatment of renal transplant stones by extracorporeal shock-wave lithotripsy in the prone position. Urology 37:57–60
Del Pizzo JJ, Sklar GN (1999) O’Brien peel-away sheath: an alternative for allograft percutaneous nephroscopy. J Endourol 13:31–33
Francesca F, Felipetto R, Mosca F, Boggi U, Rizzo G, Puccini R (2002) Percutaneous nephrolithotomy of transplanted kidney. J Endourol 16:225–227
Hulbert JC, Reddy P, Young AT, Hunter DW, Castaneda-Zuniga W, Amplatz K, Lange PH (1985) The percutaneous removal of calculi from transplanted kidneys. J Urol 134:324–326
Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, Macaluso JN Jr (1997) Ureteral Stones Clinical Guidelines Panel summary report on the management of ureteral calculi.The American Urological Association. J Urol 158:1915–1921
Green DF, Lytton B (1985) Early experience with direct vision electrohydraulic lithotripsy of ureteral calculi. J Urol 133:767–770
Preminger GM (1992) Management of ureteral calculi: the debate continues. J Urol 148:1102–1104
Mak S, Amoroso P (2003) Stop those antiplatelet drugs before surgery! BJU Int 91:593–594
Culkin DJ, Wheeler JS, Nemchausky BA, Fruin RC, Canning JR (1990) Percutaneous nephrolithotomy: spinal cord injury vs. ambulatory patients. J Am Paraplegia Soc 13:4–6
Larsen EH, Gasser TC, Madsen PO (1986) Antimicrobial prophylaxis in urologic surgery. Urol Clin N Am 13:591–604
Koo BC, Burtt G, Burgess NA (2004) Percutaneous stone surgery in the obese: outcome stratified according to body mass index. BJU Int 93:1296–1299
Pearle MS, Nakada SY, Womack JS, Kryger JV (1998) Outcomes of contemporary percutaneous nephrostolithotomy in morbidly obese patients. J Urol 160:669–673
Sherman JL, Hopper KD, Greene AJ, Johns TT (1985) The retrorenal colon on computed tomography: a normal variant. J Comput Assist Tomogr 9:339–341
Dyer RB, Assimos DG, Regan JD (1997) Update on interventional uroradiology. Urol Clin N Am 24:623–652
Kim SC, Lingeman JE (2006) Percutaneous access to the urinary tract. In: Nakada SY, Pearle MS (eds) Advanced endourology: the complete clinical guide. Humana Press, Totowa, NJ, pp 43–59
Lang EK (1987) Percutaneous nephrostolithotomy and lithotripsy: a multiinstitutional survey of complications. Radiology 162:25–30
Alken P, Hutschenreiter G, Gunther R, Marberger M (1981) Percutaneous stone manipulation. J Urol 125:463–466
Clayman RV, Surya V, Miller RP, Castaneda-Zuniga WR, Amplatz K, Lange PH (1983) Percutaneous nephrolithotomy. An approach to branched and staghorn renal calculi. JAMA 250:73–75
Kerlan RK Jr, Kahn RI, Ring EJ (1984) Percutaneous renal and ureteral stone removal. Urol Radiol 6:113–123
Davidoff R, Bellman GC (1997) Influence of technique of percutaneous tract creation on incidence of renal hemorrhage. J Urol 157:1229–1231
Al-Basam S, Bennett JD, Layton ZA, Denstedt JD, Razvi H (2000) Treatment of caliceal diverticular stones: transdiverticular percutaneous nephrolithotomy with creation of a neoinfundibulum. J Vasc Interv Radiol 11:885–889
Lang EK (1991) Percutaneous infundibuloplasty: management of calyceal diverticula and infundibular stenosis. Radiology 181:871–877
Kim SC, Kuo RL, Tinmouth WW, Watkins S, Lingeman JE (2005) Percutaneous nephrolithotomy for caliceal diverticular calculi: a novel single stage approach. J Urol 173:1194–1198
Aron M, Goel R, Kesarwani PK, Seth A, Gupta NP (2004) Upper pole access for complex lower pole renal calculi. BJU Int 94:849–852; discussion 852
Munver R, Delvecchio FC, Newman GE, Preminger GM (2001) Critical analysis of supracostal access for percutaneous renal surgery. J Urol 166:1242–1246
Stening SG, Bourne S (1998) Supracostal percutaneous nephrolithotomy for upper pole caliceal calculi. J Endourol 12:359–362
Wong C, Leveillee RJ (2002) Single upper-pole percutaneous access for treatment of or 5-cm complex branched staghorn calculi: is shockwave lithotripsy necessary? J Endourol 16:477–481
Fuchs EF, Forsyth MJ (1990) Supracostal approach for percutaneous ultrasonic lithotripsy. Urol Clin N Am 17:99–102
LeRoy AJ, Williams HJ Jr, Bender CE, Segura JW, Patterson DE, Benson RC (1985) Colon perforation following percutaneous nephrostomy and renal calculus removal. Radiology 155:83–85
Golijanin D, Katz R, Verstandig A, Sasson T, Landau EH, Meretyk S (1998) The supracostal percutaneous nephrostomy for treatment of staghorn and complex kidney stones. J Endourol 12:403–405
Narasimham DL, Jacobsson B, Vijayan P, Bhuyan BC, Nyman U, Holmquist B (1991) Percutaneous nephrolithotomy through an intercostal approach. Acta Radiol 32:162–165
Ogan K, Corwin TS, Smith T, Watumull LM, Mullican MA, Cadeddu JA, Pearle MS (2003) Sensitivity of chest fluoroscopy compared with chest CT and chest radiography for diagnosing hydropneumothorax in association with percutaneous nephrostolithotomy. Urology 62:988–992
Ogan K, Pearle MS (2002) Oops we got in the chest: fluoroscopic chest tube insertion for hydrothorax after percutaneous nephrostolithotomy. Urology 60:1098–1099
Hopper KD, Yakes WF (1990) The posterior intercostal approach for percutaneous renal procedures: risk of puncturing the lung, spleen, and liver as determined by CT. AJR Am J Roentgenol 154:115–117
Robert M, Maubon A, Roux JO, Rouanet JP, Navratil H (1999) Direct percutaneous approach to the upper pole of the kidney: MRI anatomy with assessment of the visceral risk. J Endourol 13:17–20
Kim SC, Ng JC, Matlaga BR, Lifshitz DA, Lingeman JE (2006) Use of lower pole nephrostomy drainage following endorenal surgery through an upper pole access. J Urol 175:580–584; discussion 584
Lingeman JE, Newmark JR, Wong MYC (1995) Classification and management of staghorn calculi. In: Smith AD (ed) Controversies in endourology. Saunders, Philadelphia, pp 136–144
Winfield HN, Weyman P, Clayman RV (1986) Percutaneous nephrostolithotomy: complications of premature nephrostomy tube removal. J Urol 136:77–79
Kim SC, Tinmouth WW, Kuo RL, Paterson RF, Lingeman JE (2005) Using and choosing a nephrostomy tube after percutaneous nephrolithotomy for large or complex stone disease: a treatment strategy. J Endourol 19:348–352
Carson CC III, Danneberger JE, Weinerth JL (1988) Percutaneous lithotripsy in morbid obesity. J Urol 139:243–245
Gallucci M, Fortunato P, Schettini M, Vincenzoni A (1998) Management of hemorrhage after percutaneous renal surgery. J Endourol 12:509–512
Lee WJ, Smith AD, Cubelli V, Badlani GH, Lewin B, Vernace F, Cantos E (1987) Complications of percutaneous nephrolithotomy. AJR Am J Roentgenol 148: 177–180
Carson CC (1986) Complications of percutaneous stone extraction: prevention and treatment. Semin Urol 4:161–169
Kaye KW, Clayman RV (1986) Tamponade nephrostomy catheter for percutaneous nephrostolithotomy. Urology 27:441–445
Irby PB, Schwartz BF, Stoller ML (1999) Percutaneous access techniques in renal surgery. Tech Urol 5:29–39
Picus D, Weyman PJ, Clayman RV, McClennan BL (1986) Intercostal-space nephrostomy for percutaneous stone removal. AJR Am J Roentgenol 147:393–397
Young AT, Hulbert JC, Cardella JF, Hunter DW, Castaneda-Zuniga WR, Reddy P, Amplatz K (1985) Percutaneous nephrostolithotomy: application to staghorn calculi. AJR Am J Roentgenol 145:1265–1269
Gerspach JM, Bellman GC, Stoller ML, Fugelso P (1997) Conservative management of colon injury following percutaneous renal surgery. Urology 49:831–836
Wolf JS Jr (1998) Management of intraoperatively diagnosed colonic injury during percutaneous nephrostolithotomy. Tech Urol 4:160–164
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Miller, N.L., Matlaga, B.R., Kim, S.C., Lingeman, J.E. (2006). Access Techniques for Percutaneous Renal Surgery. In: Baba, S., Ono, Y. (eds) Interventional Management of Urological Diseases. Recent Advances in Endourology, vol 8. Springer, Tokyo. https://doi.org/10.1007/978-4-431-35642-4_1
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