Cesare Marco Scoffone, András Hoznek and Cecilia Maria Cracco (eds.)Supine Percutaneous Nephrolithotomy and ECIRS2014The New Way of Interpreting PNL10.1007/978-2-8178-0459-0_1

1. Introduction

José Gabriel Valdivia Uría¹

(1)

Jefe de Servicio de Urología del Hospital Clínico Universitario “Lozano Blesa” Zaragoza, Urbanización Santa Fe, calle 4, n 13, 50410 Cuarte de Huerva, Zaragoza, Spain

José Gabriel Valdivia Uría

Email: valdivia@unizar.es

Abstract

In this introduction J.G. Valdivia Uría, the father of the supine position for percutaneous surgery, briefly describes the history of patient positioning for percutaneous renal access, the initial cooperation between urologists and radiologists, and the subsequent birth of percutaneous nephrolithotomy in all its steps, thoroughly developed by various urologists during the years. He underlines the advantages of the supine position and presents the contents of the present book, highlighting its exhaustive approach to all related issues and its practical value.

The percutaneous access to the kidney began to develop in 1954, when radiologists first dared to puncture a hydronephrotic renal pelvis in order to obtain antegrade pyelographies [1, 2].

After these initial experiences, radiologists and urologists began to perform techniques of increasing complexity such as percutaneous nephrostomy [3], extraction of kidney stones through mature tracts of previous percutaneous nephrostomies [4], and finally percutaneous nephrolithotomy (PNL), a technique that afterwards in the urologists’ hands got better and better over the years [5–8].

After defining a good technique to puncture the kidney, subsequent improvements were essentially directed at simplifying the procedure of nephrostomy tract dilatation and designing efficient instruments such as nephroscopes, stone extractors, and lithotripsy devices.

At this point it is worth remembering that initially the radiologists aimed at the direct puncture of the renal pelvis without passing through the renal parenchyma, and for that reason they placed the patient in prone position. Although it did not take long to prove the advantages and safety of puncturing the kidney via the calyceal papilla, all the same it was not considered necessary to modify the patient’s position.

The pioneering urologists in these percutaneous techniques described several anatomic references in the lumbar area (points, lines, and angles) in the attempt to simplify the procedure of the renal puncture and make it accessible to all urologists. The radiological C arm was from the very beginning a necessary prerequisite, thanks to its ability to show the path of the puncture needle from different angles.

Some urologists, facing the complexity of this step, refused to perform the initial percutaneous approach themselves, leaving it instead to the radiologists, so that they were used to performing only the endoscopic part of the PNL.

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