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Ultrasound-guided access and dilation for percutaneous nephrolithotomy (PCNL) in the supine position: A step-by-step approach

Urology Aug 05, 2019

Tzou DT, et al. - Experts demonstrated a step-by-step procedure for performing percutaneous nephrolithotomy (PCNL) in the supine position, solely under ultrasound guidance through a video. Significant anatomic landmarks are recognized once in the modified supine (Galdakao-modified Valdivia) position. The anatomic landmarks that oriented the probe to the location of the kidney were the 11th and 12th ribs, paraspinous muscle, iliac crest, mid-axillary line, and costal margin. Locating the ultrasound probe in the mid-axillary line, parallel to the 11th rib permitted the operator to recognize key renal landmarks ie, the renal cortex, peri-pelvic fat, collecting system, kidney stone with its related postacoustic shadow, and the intended target calyx. In the longitudinal view, controlling the needle was easiest as the needle could be seen from skin to target. Dilation under ultrasound was dependent on keeping the wire in view. The tip of the 10-French dilator was on the basis of location where the wire image disappeared as the dilator advanced. The balloon dilator tip was visualized on ultrasound reaching the relevant depth just inside the collecting system, at which time balloon inflation led to complete dilation of the tract. Hence, the video gave a step-by-step procedure exhibiting that PCNL could be done in the supine position using just ultrasound-guidance. This approach promoted renal access in this position and prevented the requirement for radiation exposure.
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