Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance

Introduction Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large kidney stones. Second-look nephroscopy is one of the methods for removing residual stone fragments after PCNL. During second-look nephroscopy, we pass a guidewire through the previously established nephrostomy tra...

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Autores principales:	Seyed Mohammad Kazem Aghamir, Fatemeh Dadkhah Tehrani, Fatemeh Khatami, Hamidreza Zia
Formato:	article
Lenguaje:	EN
Publicado:	Urology Research Center 2020
Materias:	percutaneous nephrolithotomy second-look nephroscopy kidney stones nephrostomy Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/dc47ba8539824d21ad915fe06317c17a
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spelling	oai:doaj.org-article:dc47ba8539824d21ad915fe06317c17a2021-11-30T05:20:49ZSecond-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance10.22034/TRU.2020.256840.10432717-042Xhttps://doaj.org/article/dc47ba8539824d21ad915fe06317c17a2020-11-01T00:00:00Zhttps://www.transresurology.com/article_119771.htmlhttps://doaj.org/toc/2717-042XIntroduction Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large kidney stones. Second-look nephroscopy is one of the methods for removing residual stone fragments after PCNL. During second-look nephroscopy, we pass a guidewire through the previously established nephrostomy tract, which was impossible in this case. Thus, we performed the procedure with direct tract ureteroscopy and simultaneous fluoroscopy. Case presentation A 45-year-old man with full staghorn calculi was the case of this study. We performed PCNL surgery on him, but because of tachycardia and a fall in the patients’ blood pressure, we terminated the surgery after 3 hours. Because of the high possibility of remaining stones, we inserted a Foley 16 catheter as a nephrostomy. In the performed computerized tomography (CT) scan two days after the surgery, a significant volume of stone residue was observed. Four days after surgery, the patient was transferred to the operating room after the improvement of clinical status and hematuria resolved. The procedure was done when the patient was in the prone position and under general anesthesia. After cutting the nephrostomy tube, the attempt to insert the wire was not successful. So, we removed the nephrostomy tube. After retrograde injection of the contrast agent and fluoroscopy, we observed the contrasting agent passage through the nephrostomy tract to the skin surface. We found the main tract with simultaneous ureteroscopy and fluoroscopy. then insert guidewire in the renal pelvis and nephroscopy through the wire. Conclusions With the help of ureteroscopy and direct vision and fluoroscopy, we found the previous tract, entered the pyelocaliceal system, and embedded the guidewire. Thus, we performed nephroscopy from the same tract site without the need to get re-access.Seyed Mohammad Kazem Aghamir Fatemeh Dadkhah Tehrani Fatemeh Khatami Hamidreza Zia Urology Research Centerarticlepercutaneous nephrolithotomysecond-look nephroscopykidney stonesnephrostomyDiseases of the genitourinary system. UrologyRC870-923ENTranslational Research in Urology, Vol 2, Iss 4, Pp 118-122 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	percutaneous nephrolithotomy second-look nephroscopy kidney stones nephrostomy Diseases of the genitourinary system. Urology RC870-923
spellingShingle	percutaneous nephrolithotomy second-look nephroscopy kidney stones nephrostomy Diseases of the genitourinary system. Urology RC870-923 Seyed Mohammad Kazem Aghamir Fatemeh Dadkhah Tehrani Fatemeh Khatami Hamidreza Zia Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance
description	Introduction Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large kidney stones. Second-look nephroscopy is one of the methods for removing residual stone fragments after PCNL. During second-look nephroscopy, we pass a guidewire through the previously established nephrostomy tract, which was impossible in this case. Thus, we performed the procedure with direct tract ureteroscopy and simultaneous fluoroscopy. Case presentation A 45-year-old man with full staghorn calculi was the case of this study. We performed PCNL surgery on him, but because of tachycardia and a fall in the patients’ blood pressure, we terminated the surgery after 3 hours. Because of the high possibility of remaining stones, we inserted a Foley 16 catheter as a nephrostomy. In the performed computerized tomography (CT) scan two days after the surgery, a significant volume of stone residue was observed. Four days after surgery, the patient was transferred to the operating room after the improvement of clinical status and hematuria resolved. The procedure was done when the patient was in the prone position and under general anesthesia. After cutting the nephrostomy tube, the attempt to insert the wire was not successful. So, we removed the nephrostomy tube. After retrograde injection of the contrast agent and fluoroscopy, we observed the contrasting agent passage through the nephrostomy tract to the skin surface. We found the main tract with simultaneous ureteroscopy and fluoroscopy. then insert guidewire in the renal pelvis and nephroscopy through the wire. Conclusions With the help of ureteroscopy and direct vision and fluoroscopy, we found the previous tract, entered the pyelocaliceal system, and embedded the guidewire. Thus, we performed nephroscopy from the same tract site without the need to get re-access.
format	article
author	Seyed Mohammad Kazem Aghamir Fatemeh Dadkhah Tehrani Fatemeh Khatami Hamidreza Zia
author_facet	Seyed Mohammad Kazem Aghamir Fatemeh Dadkhah Tehrani Fatemeh Khatami Hamidreza Zia
author_sort	Seyed Mohammad Kazem Aghamir
title	Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance
title_short	Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance
title_full	Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance
title_fullStr	Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance
title_full_unstemmed	Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance
title_sort	second-look percutaneous nephrolithotomy: access to the tract with direct vision and fluoroscopic guidance
publisher	Urology Research Center
publishDate	2020
url	https://doaj.org/article/dc47ba8539824d21ad915fe06317c17a
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Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance

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