Main Article Content
Special access techniques during percutaneous nephrolithotomy (PCNL) are indicated for challenging stones. Various techniques have been described to inferiorly displace the kidney to facilitate optimal percutaneous access whilst minimizing thoracic complications associated with the supracostal approach.
We describe our institution’s technique of using a ureteric balloon catheter to inferiorly distract and immobilize the kidney (UBC Technique) to achieve the optimal calyceal access infracostally during PCNL. This permits effective and safe access in a single puncture whilst additionally stabilizing the renal unit during respiration and reducing the skin-to-calyceal distance by mobilizing the desired calyx in line with the axis of the puncture needle. We reviewed the literature regarding alternative inferior renal displacement techniques permitting infracostal approaches.
From May 2012 to October 2017 150 PCNLs were performed in our institution. Out of these, the UBC technique was used in 18 cases during both prone and supine PCNLs. In all cases, the UBC technique was used successfully to access the most desirable calyx. No complications associated with renal distraction were reported. Post operatively, 1 patient required a blood transfusion, 1 patient had a pyrexia of >38 degrees resulting in a longer admission and 1 patient developed sepsis requiring HDU admission for monitoring only. 15 out the 18 patients had complete stone clearance from their PCNL.
The UBC technique provides a safe alternative to the supracostal approach in percutaneous renal surgery. It is less traumatic than alternative infracostal access techniques and has a very short learning curve.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of articles published in all DPG titles is retained by the author(s). The author(s) grants DPG the rights to publish the article and identify itself as the original publisher. The author grants DPG exclusive commercial rights to the article. The author grants any party the rights to use the article freely for non-commercial purposes provided that the original work is properly cited.
2. Goyal A, Mukherjee K, Karaolides T et al. Inferior distraction of the kidney to aid upper pole and supracostal punctures during supine percutaneous renal access. J Urol 2012;9:706–10.
3. Gupta R, Kumar A, Kapoor R, Srivastava A, Mandhani A. prospective evaluation of safety and efficacy of the supracostal approach for percutaneous nephrolithotomy. BJU Int 2002;90:809–13.
4. Shaban A, Kodera A, El Ghoneimy MN, Orban TZ, Mursi K, Hegazy A. Safety and efficacy of supracostal access in percutaneousrenal surgery. J Endourol 2008;22:29–34.
5. Kekre NS, Gopalakrishnan GG, Gupta GG, Abraham BN, Sharma E. Supracostal approach in percutaneous nephrolithotomy: experience with 102 cases. J Endourol 2001;15:789–91.
6. Young AT, Hunter DW, Castaneda-Zuniga WR, et al. Percutaneous extraction of urinary calculi: use of the intercostal approach. Radiology 1985;154:633–8.
7. Forsyth MJ, Fuchs EF. The supracostal approach for percutaneous nephrostolithotomy. J Urol 1987;137:197–8.
8. Narasimham DL, Jacobsson B, Vijayan P, Bhuyan BC, Nyman U, Holmquist B. Percutaneous nephrolithotomy through anintercostal approach. Acta Radiol 1991;32:162–5.
9. Lashley DB, Fuchs EF. Urologist-acquired renal access for percutaneous renal surgery. Urology 1998;51:927–31.
10. Munver R, Delvecchio FC, Newman GE, Preminger GM. Critical analysis of supracostal access for percutaneous renal surgery Urol 2001;166:1242–6.
11. Radecka E, Brehmer M, Holmgren K, et al. Complications associated with percutaneous nephrolithotripsy: Supra- versus subcostal access. A retrospective study. Acta Radiol 2007;44:447–51. http://dx.doi.org/10.1016/j.juro.2007.03.014
12. Schwartz LH, Richaud J, Buffat L, et al. Kidney mobility during respiration. Radiother Oncol 1994;32:84–6. https://doi.org/10.1016/0167-8140(94)90452-9
13. Karlin GS, Smith AD. Approaches to the superior calix: Renal displacement technique and review of options. J Urol 1989;142:774–77. http://dx.doi.org/10.1016/S0022-5347(17)38884-5
14. McDougall EM, Liatsikos EN, Dinlenc CZ et al. Percutaneous approach to the urinary tract. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell’s Urology. 8th ed. Philadelphia: Saunders; 2002.
15. Lezrek M, Bazine K, Abdelghani A, et al. Need renal displacement technique for the percutaneous approach to the superior calyx. J Endouro 2011;25(11):1723–26. https://doi.org/10.1089/end.2010.0721.