PLANING RENAL PUNCTURE IN MINI-PERCUTANEOUS NEPHROLITHOTOMY:A RADIOLOGICAL ANATOMYBASED INTERVENTION

Abstract

Objectives: To determine the outcome of mini-PCNL in terms of stone clearance considering
renal puncture through diff erent calyces under fl uoroscopy.
Materials and Methods: This study was conducted in the Department of Urology Institute of
Kidney Diseases , Peshawar from 1st Jan 2022 to 31st May 2022. Patients fulfi lling the study
criteria having renal stone≥2cm were recruited for the study. All the patients having abnormal blood caogulopathy and abnormal anatomy were excluded from the study. The cystoscopy
was performed fi rst by keeping the patient in the lithotomy position and the ureteric catheter
was passed. The anatomy of kidney is fully visualized targeting the calyx with gradual descent
technique under fl uoroscopic guidance. Renal access to pelvicalyceal (PVC) system achieved
percutaneously under fl uoroscopic guidance by renal puncture through diff erent calyces after
which which guide wire was passed. The percutaneous tract was made and dilated up to 17Fr
by using single-step metalic dilator and a 12-Fr-sized nephroscope was used. The stones were
broken into pieces using pneumatic lithoclast.
Results: Mean stone size was 15.35+3.073. Mean hospital stay was 2.62+0.487. Ninety six(60%)
were male patients while 64 (40%) were female patients. 71.9%(115) patients achieved stone
clearance by intervention through middle calyx while 21.85% (35) and 7%(10) patients achieved
full stone clearance through upper and lower calyx approach respectively.
Conclusion: The approach to the pelvicalyceal system through proper planning of renal puncture under fl uoroscopic guidance turns signifi cantly good in case of middle calyceal approach
in terms of stone clearance.