Morshed Salah
Al Wakra Hospital, Qatar
Title: Access to the kidney during percutaneous nephrolithotomy
Biography
Biography: Morshed Salah
Abstract
Percutaneous Nephrolithotomy (PCNL) is the first-line treatment modality for the management of kidney stones larger than 2 cm in diameter. The creation of a percutaneous renal access is the most important step in PCNL and the adequacy of the access directly influences the success and complication rates of this procedure. Several techniques have been used for guidance for entrance to the collecting system, including fluoroscopy, computed tomography (CT) and ultrasonography (US), however access under fluoroscopy is the most commonly used. The aim of this presentation is to emphasize the importance of the renal access, mainly the monoplanar technique, during PCNL. The access under fluoroscopy control can be performed either under biplanar or monoplanar guidance. Biplanar access is based on the cephalad-caudad and mediolateral movements of the needle; the depth of the needle is adjusted with using fluoroscopic imaging in 30 degree and vertical positions. Monoplanar access is based on the intensive movement of the kidney and the retraction of the targeted calyx under fluoroscopy on a vertical plane only. The monoplanar access technique is a safe method, it decreases puncture and radiation time, it minimizes the patient's, the surgeon's and stuff's direct exposure time to radiation and it has similar success rates as the biplanar access technique.