Retrograde nephrostomy access for percutaneous nephrolithotomy: a simple and safe technique

Abstract

This study aimed at illustrating our experiencewith the retrograde nephrostomy access technique for percutaneous nephrolithotomy (PCNL).This retrospective study was conducted between June 1997 and September 2018 for 648 patients who underwent PCNL with retrograde nephrostomy access. Included in the study were the patient demographic, operative time, site of the access, fluoroscopic exposure time, stone clearance rate, additional procedures and complications. A total of 648 patients aged between 25 and 70 years had renal stones and were included in this study. Retrograde nephrostomy access was achieved through the upper calyx in 252 patients (38.9%), middle calyx in 348 patients (53.7%) and lower calyx in 48 patients (7.4%). Among those patients, 108 (16.7%) required supracostal access.The average time for the retrograde access and PCNL was 14.4 min and 40 min, respectively. The average fluoroscopic exposure time for the retrograde access was 3.2 min. There were 12 failures (1.9%) as a result of severe hydronephrosis. Complete stone clearance was achieved in 91.8%. Small stone fragments (4 mm or less) were detected in 7.4%. Median hospital stay was 3.5 days (range 3–7). Complications occurred in 39 patients (6%). Eight patients (1.2%) developed significant postoperative hemorrhage that was controlled by transfusion and angioembolization. There were no recorded cases of colonic injuries, pneumothorax or hemothorax, demonstrating that the retrograde access technique is safe and reliable. It provides control over both ends of the wire eliminating the risk of accidental wire displacement. Radiation exposure is minimal. There are low failure and complication rates.