V1720: Simplified method of percutaneous nephrolithotomy in the simple malrotation: Technical aspects
VideoIntroduction and Objectives
Renal malrotation is a malformation that is generally combined with other kidney anomalies. The isolated entity known as simple malrotation is rarely seen in a PCNL procedure. Simplified technique is a method described as a renal percutaneous approach that creates a plane of coincidence between the C arm beam axis and the needle axis. We are going to show the feasibility of this technique in the simple malrotation.
We present a video, with a female patient with a 1.4 cm stone, with 1116 Hounsfield units in a malrotated kidney. A percutaneous approach was planned with the patient in prone position. The inferior calyx was selected in this case, and it was marked with the C arm angulated as usual for this technique and the entrance point was selected. A more vertical puncture, parallel to the intervertebral muscle, was done with success. Dilation as well as stone management was accomplished, keeping the vertical orientation at all time. A stone free status was reached for this patient.
The technique shown in the video was applied to 6 consecutive patients with this infrequent malformation. The mean stone size was 2.1 cm, 4 of them were located in the renal pelvis, a mean operative time of 52 minutes was recorded, a hemoglobin decrease of o.6 g/dl, mean hospital stay of 1.3 days, and the stone free status was reached in all patients.
The simplified percutaneous nephrolithotomy tecnique is a rapid, safe, and effective method for renal access in the simple malrotation. We consider that it can also be applied to other renal anomalies with posterior facing calyces.