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64 Tips to make percutaneous nephrolithotomy easier

Aasem Chaudry

Securing the percutaneous nephrolithotomy tract

Percutaneous nephrolithotomy (PCNL) is a procedure frequently performed to treat renal stones. While this procedure has been in vogue for over two decades, there remains a wide variation in the techniques used. The technique has developed over time and continues to be improved. Traditionally, it was performed in a prone or semi-prone position but recently supine PCNL has become popular. Regardless of the position used, securing the tract after the initial successful puncture of the collecting system until completion remains a challenge. Loss of the tract during the procedure can be quite frustrating and re-entry into the collecting system can be quite difficult and at times unsuccessful. The technique described minimises the chances of this happening.

The use of a through-and-through guidewire passed via the ureteric access catheter from below and brought out of the PCN tract through the Amplatz sheath wherever possible is the best way of avoiding this complication. The guidewire is secured at both ends using simple artery forceps and is kept in place until completion of the procedure. If the Amplatz sheath slips out of the collecting system, re-entry is fairly straightforward and atraumatic.