V6-07: retrograde percutaneous nephrostomy¡ªEstablishment of percutaneous renal channel holmium laser wire puncture from renal calyx to the skin under visualized of flexible ureteroscope (a report of 12 cases and typical medical surgery video)

Video

Introductions and Objectives
To explore the feasibility of retrograde percutaneous nephrostomy.

Methods
Patients take the lithotomy position or lithotomy lateral position with ipsilateral lumbar vacant£¬under general anesthesia and disinfection£¬Transurethral the flexible ureteroscope(National Patent No. 2014204583688) which could be visualized under ultrasonography was inserted into the ureter and renal pelvis.We carefully observed the target calculi , tip of flexible ureteroscope and define appropratie renal calyx to puncture under the B-ultrasound guided. Thereafter, a proper holmium laser puncture wire was carefully inserted into the flexible ureteroscope . The flexible ureteroscope approached the desired renal calyx again, and the route from the renal calyx to exiting the skin was then confirmed under ultrasonography. The holmium laser£¨versaPulse 30W£© puncture was performed under ultrasonography. Next, the needle dilator were placed over the puncture wire, which was advanced through the skin until it reached the renal parenchyma. A safety guidewire was placed £¬Every expansion sheath into the calyx was visualized under flexible ureteroscope.

Results
Twelve patients were included in this study £¨5 males, including four cases of unilateral, bilateral one case; female four cases, including two cases of unilateral, bilateral two cases£©who all had renal or ureteral stones.Nine patients puncture once success£¬two cases puncture twice and one case puncture three. None of the patients required a blood transfusion.There was no one intraoperative complication in the ureteroscopy-assisted retrograde nephrolithotomy.

Conclusions
Establishment of percutaneous renal channel holmium laser wire puncture from renal calyx to skin under visualized of flexible ureteroscope was an effective method.The advantages of performance were as follow:first, the puncture target (precisely one point) reverse surface (not a point but a surface).Second, previous ureteroscopy for renal calyx, renal pelvis and ureter lesions had a clear diagnosis.Third, We observed the target calculi, tip of flexible ureteroscope and defined the appropriate renal calyx to puncture under ultrasonography. Fourth, using ultrasound and flexible ureteroscope guidance, the renal parenchyma thickness can be evaluated with more accurate access to puncture without injury to the adjacent organs and large vessels.

Funding: none