eMedicine Specialties > Urology > Stones

Percutaneous Endourology: Multimedia

Author: Michael Grasso, MD, Chairman, Department of Urology, Saint Vincent's Medical Center; Professor and Vice Chairman, Department of Urology, New York Medical College
Coauthor(s): Andrew Ira Fishman, MD, Staff Physician, Department of Urology, Saint Vincent Catholic Medical Center; Keith T Tracy, MD, Staff Physician, Department of Urology, New York Medical College, Westchester Medical Center
Contributor Information and Disclosures

Updated: Feb 15, 2008

Multimedia

The patient is a 10-month-old girl with a history...
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Media file 1: The patient is a 10-month-old girl with a history of fever and recurrent urinary tract infections. Plain radiograph demonstrates multiple large renal calculi.
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The patient is a 10-month-old girl with a history...

The patient is a 10-month-old girl with a history of fever and recurrent urinary tract infections. Plain radiograph demonstrates multiple large renal calculi.

Retrograde ureteropyelogram that demonstrates a s...
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Media file 2: Retrograde ureteropyelogram that demonstrates a severely hydronephrotic kidney with multiple large intrarenal and ureteral calculi.
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Retrograde ureteropyelogram that demonstrates a s...

Retrograde ureteropyelogram that demonstrates a severely hydronephrotic kidney with multiple large intrarenal and ureteral calculi.

Initial percutaneous renal access obtained via a ...
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Media file 3: Initial percutaneous renal access obtained via a lower-pole puncture.
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Initial percutaneous renal access obtained via a ...

Initial percutaneous renal access obtained via a lower-pole puncture.

After initial needle access is obtained, a guidew...
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Media file 4: After initial needle access is obtained, a guidewire is coiled in the renal pelvis prior to tract dilation.
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After initial needle access is obtained, a guidew...

After initial needle access is obtained, a guidewire is coiled in the renal pelvis prior to tract dilation.

After tract dilation, the calculi are treated wit...
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Media file 5: After tract dilation, the calculi are treated with a rigid nephroscope and ultrasonic lithotriptor. A 7.5F flexible nephroscope and a laser lithotriptor are used to treat stones in tangential calyces. All aspects of the intrarenal collecting system are accessible, which requires both primary and secondary deflection.
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After tract dilation, the calculi are treated wit...

After tract dilation, the calculi are treated with a rigid nephroscope and ultrasonic lithotriptor. A 7.5F flexible nephroscope and a laser lithotriptor are used to treat stones in tangential calyces. All aspects of the intrarenal collecting system are accessible, which requires both primary and secondary deflection.

Following treatment of the large stone burden, th...
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Media file 6: Following treatment of the large stone burden, the remainder of the collecting system is examined in an antegrade manner via flexible ureteroscopy.
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Following treatment of the large stone burden, th...

Following treatment of the large stone burden, the remainder of the collecting system is examined in an antegrade manner via flexible ureteroscopy.

Following the procedure, a 14F Malecot nephrostom...
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Media file 7: Following the procedure, a 14F Malecot nephrostomy tube and a 5F nephroureteral stent are placed for renal drainage.
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Following the procedure, a 14F Malecot nephrostom...

Following the procedure, a 14F Malecot nephrostomy tube and a 5F nephroureteral stent are placed for renal drainage.

More on Percutaneous Endourology

Overview: Percutaneous Endourology
Workup: Percutaneous Endourology
Treatment: Percutaneous Endourology
Follow-up: Percutaneous Endourology
Multimedia: Percutaneous Endourology
References
Further Reading
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References

  1. Goodwin WE, Casey WC, Woolf W. Percutaneous trocar (needle) nephrostomy in hydronephrosis. J Am Med Assoc. Mar 12 1955;157(11):891-4. [Medline].

  2. Fernström I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol. 1976;10(3):257-9. [Medline].

  3. Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS Jr, et al. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. Jun 2005;173(6):1991-2000. [Medline].

  4. Gill IS, Desai MM, Kaouk JH, Wani K, Desai MR. Percutaneous endopyeloplasty: description of new technique. J Urol. Nov 2002;168(5):2097-102. [Medline].

  5. Desai MM, Desai MR, Gill IS. Endopyeloplasty versus endopyelotomy versus laparoscopic pyeloplasty for primary ureteropelvic junction obstruction. Urology. Jul 2004;64(1):16-21; discussion 21. [Medline].

  6. Jackman SV, Hedican SP, Docimo SG, et al. Miniaturized access for pediatric percutaneous nephrolithotomy. J Endourol. 1997;11:S133.

  7. Feng MI, Tamaddon K, Mikhail A, Kaptein JS, Bellman GC. Prospective randomized study of various techniques of percutaneous nephrolithotomy. Urology. Sep 2001;58(3):345-50. [Medline].

  8. Deane LA, Clayman RV. Advances in percutaneous nephrostolithotomy. Urol Clin North Am. Aug 2007;34(3):383-95. [Medline].

  9. Mikhail AA, Kaptein JS, Bellman GC. Use of fibrin glue in percutaneous nephrolithotomy. Urology. May 2003;61(5):910-4; discussion 914. [Medline].

  10. Alken P, Hutschenreiter G, Günther R, Marberger M. Percutaneous stone manipulation. J Urol. Apr 1981;125(4):463-6. [Medline].

  11. Blandy JP, Singh M. The case for a more aggressive approach to staghorn stones. J Urol. May 1976;115(5):505-6. [Medline].

  12. Bloom DA, Morgan RJ, Scardino PL. Thomas Hillier and percutaneous nephrostomy. Urology. Apr 1989;33(4):346-50. [Medline].

  13. Buchholz NP. Three-dimensional CT scan stone reconstruction for the planning of percutaneous surgery in a morbidly obese patient. Urol Int. 2000;65(1):46-8. [Medline].

  14. Wein A, Kavoussi L, Novick A, Partin A, Peters C, eds. Campbell-Walsh Urology. Vol 2. 9th ed. Philadelphia, PA: WB Saunders; 2007:1526-63.

  15. Clayman RV, Castaneda-Zuniga WR. Rigid and flexible nephroscopy. In: Techniques in Endourology: A Guide to the Percutaneous Removal of Renal and Ureteral Calculi. Chicago, Ill: Yearbook Medical Publishers; 1984:153.

  16. Clayman RV, Kavoussi LR. Endosurgical Techniques for Noncalculous Disease. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, eds. Campbell's Urology. 6th ed. Philadelphia, Pa: WB Saunders; 1992:2231.

  17. Coleman CC, Kimura Y, Reddy P. Complications of nephrostolithotomy. Sem Intervent Radiol. 1984;1:24.

  18. Grasso M, Lang G, Loisides P, Bagley D, Taylor F. Endoscopic management of the symptomatic caliceal diverticular calculus. J Urol. Jun 1995;153(6):1878-81. [Medline].

  19. Grasso M, Loisides P, Beaghler M, Bagley D. The case for primary endoscopic management of upper urinary tract calculi: I. A critical review of 121 extracorporeal shock-wave lithotripsy failures. Urology. Mar 1995;45(3):363-71. [Medline].

  20. Grasso MG, Taylor F. Techniques For Percutaneous Renal Access. In: Sosa RE, Albala DM, Jenkins AD, Perlmutter AP, eds. Textbook of Endourology. ed. Philadelphia, Pa: WB Saunders; 1996:99-114.

  21. Grotas A, Grasso M. Endoluminal sonographic imaging of upper urinary tract: three-dimensional reconstruction. J Endourol. Jun 2001;15(5):485-8. [Medline].

  22. Healy KA, Ogan K. Pathophysiology and management of infectious staghorn calculi. Urol Clin North Am. Aug 2007;34(3):363-74. [Medline].

  23. Jackman SV, Docimo SG, Cadeddu JA, Bishoff JT, Kavoussi LR, Jarrett TW. The "mini-perc" technique: a less invasive alternative to percutaneous nephrolithotomy. World J Urol. 1998;16(6):371-4. [Medline].

  24. Kirkali Z, Tuzel E. Transitional cell carcinoma of the ureter and renal pelvis. Crit Rev Oncol Hematol. Aug 2003;47(2):155-69. [Medline].

  25. Knudsen BE, Cook AJ, Watterson JD, Beiko DT, Nott L, Razvi H, et al. Percutaneous antegrade endopyelotomy: long-term results from one institution. Urology. Feb 2004;63(2):230-4. [Medline].

  26. Lam HS, Lingeman JE, Mosbaugh PG, Steele RE, Knapp PM, Scott JW, et al. Evolution of the technique of combination therapy for staghorn calculi: a decreasing role for extracorporeal shock wave lithotripsy. J Urol. Sep 1992;148(3 Pt 2):1058-62. [Medline].

  27. Leder RA, Nelson RC. Three-dimensional CT of the genitourinary tract. J Endourol. Feb 2001;15(1):37-46. [Medline].

  28. LeRoy AJ, Williams HJ Jr, Bender CE, Segura JW, Patterson DE, Benson RC. Colon perforation following percutaneous nephrostomy and renal calculus removal. Radiology. Apr 1985;155(1):83-5. [Medline].

  29. Limb J, Bellman GC. Tubeless percutaneous renal surgery: review of first 112 patients. Urology. Apr 2002;59(4):527-31; discussion 531. [Medline].

  30. Liu JB, Miller LS, Bagley DH, Goldberg BB. Endoluminal sonography of the genitourinary and gastrointestinal tracts. J Ultrasound Med. Mar 2002;21(3):323-37. [Medline].

  31. Murphy DP, Gill IS, Streem SB. Evolving management of upper-tract transitional-cell carcinoma at a tertiary-care center. J Endourol. Sep 2002;16(7):483-7. [Medline].

  32. Nagele U, Schilling D, Anastasiadis AG, Corvin S, Seibold J, Kuczyk M, et al. Closing the tract of mini-percutaneous nephrolithotomy with gelatine matrix hemostatic sealant can replace nephrostomy tube placement. Urology. Sep 2006;68(3):489-93; discussion 493-4. [Medline].

  33. Noller MW, Baughman SM, Morey AF, Auge BK. Fibrin sealant enables tubeless percutaneous stone surgery. J Urol. Jul 2004;172(1):166-9. [Medline].

  34. Picus D, Weyman PJ, Clayman RV, McClennan BL. Intercostal-space nephrostomy for percutaneous stone removal. AJR Am J Roentgenol. Aug 1986;147(2):393-7. [Medline].

  35. Rapp DE, Gerber GS. Management of caliceal diverticula. J Endourol. Nov 2004;18(9):805-10. [Medline].

  36. Segura JW, Preminger GM, Assimos DG, Dretler SP, Kahn RI, Lingeman JE, et al. Nephrolithiasis Clinical Guidelines Panel summary report on the management of staghorn calculi. The American Urological Association Nephrolithiasis Clinical Guidelines Panel. J Urol. Jun 1994;151(6):1648-51. [Medline].

  37. Shah HN, Kausik V, Hedge S, Shah JN, Bansal MB. Initial experience with hemostatic fibrin glue as adjuvant during tubeless percutaneous nephrolithotomy. J Endourol. Mar 2006;20(3):194-8. [Medline].

  38. Smith AD. Management of iatrogenic ureteral strictures after urological procedures. J Urol. Dec 1988;140(6):1372-4. [Medline].

  39. Sung YM, Choo SW, Jeon SS, Shin SW, Park KB, Do YS. The "mini-perc" technique of percutaneous nephrolithotomy with a 14-Fr peel-away sheath: 3-year results in 72 patients. Korean J Radiol. Jan-Mar 2006;7(1):50-6. [Medline].

  40. Tan BJ, Smith AD. Ureteropelvic junction obstruction repair: when, how, what?. Curr Opin Urol. Mar 2004;14(2):55-9. [Medline].

  41. Uribe CA, Eichel L, Khonsari S, Finley DS, Basillote J, Park HK, et al. What happens to hemostatic agents in contact with urine? An in vitro study. J Endourol. Apr 2005;19(3):312-7. [Medline].

  42. Watterson JD, Soon S, Jana K. Access related complications during percutaneous nephrolithotomy: urology versus radiology at a single academic institution. J Urol. Jul 2006;176(1):142-5. [Medline].

  43. Whitaker RH. An evaluation of 170 diagnostic pressure flow studies of the upper urinary tract. J Urol. May 1979;121(5):602-4. [Medline].

  44. Winfield HW, Clayman RV. Complications of percutaneous removal of renal and ureteral calculi. Part I. World Urology Update Series. 1985;2:Lesson 37.

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Further Reading

For additional information, see Medscape’s Stone Disease Resource Center.

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Keywords

percutaneous endourology, PCNL, PERC, kidney, upper urinary tract, catheterization, catheter, drainage, endoscopic, endoscope, kidney stones, stones, large stone burdens, strictures, ureteropelvic junction obstruction, UPJ obstruction, upper-tract lesion, upper tract lesion, antegrade pyelography, pressure/perfusion study, Whitaker test, nephrostomy catheter drainage, antegrade ureteral stenting, ureteral stricture, percutaneous endopyelotomy, percutaneous nephrostolithotomy, percutaneous nephrolithotomy, perfusion chemolysis, renal stone, endoscopic resection, urothelial tumor, laparoscopic pyeloplasty, percutaneous endopyeloplasty, mini-perc, tubeless PCNL, tubeless percutaneous nephrolithotomy, tubeless percutaneous nephrostolithotomy, percutaneous access, staghorn calculus

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Contributor Information and Disclosures

Author

Michael Grasso, MD, Chairman, Department of Urology, Saint Vincent's Medical Center; Professor and Vice Chairman, Department of Urology, New York Medical College
Michael Grasso, MD is a member of the following medical societies: American Medical Association, American Urological Association, California Medical Association, and Endourological Society
Disclosure: Karl Storz Endoscopy Consulting fee Consulting; Boston Scientific Consulting fee Consulting; Cook Urologic Consulting fee Consulting

Coauthor(s)

Andrew Ira Fishman, MD, Staff Physician, Department of Urology, Saint Vincent Catholic Medical Center
Andrew Ira Fishman, MD is a member of the following medical societies: American Medical Association and American Urological Association
Disclosure: Nothing to disclose.

Keith T Tracy, MD, Staff Physician, Department of Urology, New York Medical College, Westchester Medical Center
Keith T Tracy, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, and American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Allen Donald Seftel, MD, Professor, Department of Urology, Case School of Medicine
Allen Donald Seftel, MD is a member of the following medical societies: Ohio State Medical Association
Disclosure: lilly Consulting fee Consulting; sanofi-aventis Consulting fee Consulting; auxilium Consulting fee Consulting; solvay Consulting fee Consulting; plethora Grant/research funds clinical trial; indevus Consulting fee Consulting; nature publishing  journal editor

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Shlomo Raz, MD, Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine
Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Bradley Fields Schwartz, DO, FACS, Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine
Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Association of Military Osteopathic Physicians and Surgeons, Endourological Society, Society of Laparoendoscopic Surgeons, and Society of University Urologists
Disclosure: Nothing to disclose.

 
 
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