COMBINED (FLEXIBLE AND RIGID) NEPHROLITHOTRIPSY: SINGLE UPPER CALIX ACCESS IN SUPINE POSITION FOR THE TREATMENT OF A STAGHORN RENAL STONE

Abstract

We present the technique of a single upper calix access percutaneous nephrolitotripsy in a right kidney staghorn stone with the patient in supine position.
A 69 years old man with a complete staghorn stone of the right kidney underwent a percutaneous lithotripsy. With the patient in Galdakao supine position, we inserted a balloon occlusion ureteral catheter and performed an ultrasound guided puncture of the upper calyx. A guide wire was inserted; it passed the stone and reached the bladder. A “one-shot” tract dilation was performed and an Amplatz sheet was inserted. We performed an ultrasound/mechanic combined lithotripsy, freeing the upper calyxes, the pelvis and part of the lower calyxes, then we utilized the Holmium laser, through a 16F flexible Video Nephroscope, in order to treat the calculi of the lower and middle calyxes. Finally a 12F nephrostomy tube and a 7F ureteral catheter were left in place.
The operative time was 3 hours and 40 minutes with a near complete freeing of the kidney. The ureteral catheter was removed on the 1st day, the nephrostomy tube on the second day and the patient was discharged on the 3rd day. No major or minor complications were recorded.