Combined Direct Visual and Imaging Guided Percutaneous Nephrolithotomy: A Novel Technique

Introduction Percutaneous nephrolithotomy (PCNL) is a common urological procedure. Obtaining secure percutaneous access to the collecting system which is usually done under fluoroscopic guidance and tract dilatation is a crucial step toward a successful and safe procedure. The aim of this study is to introduce a novel technique to modify this procedure. Method Combined Direct Visual and Imaging Guided PCNL is performed by using specific 28 Fr dilatators with a customized central lumen which accepts a 4.5 F semi-rigid ureteroscope to visually confirm the puncture of target calyx and passing a guidewire. This instrument was passed as a one-shot dilator after the withdrawal of the puncture needle. The rest of the procedure was then carried out in a standard manner. This novel technique was introduced in 12 patients in 2020 in Sina hospital, after completing the informed consent. Results The mean age was 53.58±11.96 and the average stone size was 4.1±0.58 cm and the average time from insertion of the needle into target calyx until securing a guide-wire inside the collecting system (pelvis, ureter) was 95 seconds (84-107). Fluoroscopy time (total time required to obtain the access but not the whole operation) was averagely 30.25±8.01 seconds. There were no intraoperative or postoperative complications as a result of this technique. Conclusions Use of the ureteroscope loaded with the dilator and sheath during PNCL, seems to be a feasible and safe technique for dilatation of access tract during one shot PCNL.