Difficult Renal Stones
Stones to Access
is imperative to understand the pelvocaliceal anatomy before embarking
on an endourological procedure. Anatomical anomalies of the urinary
tract may thwart treatment efforts leading to failure and morbidity.
Urolithiasis in the ectopic kidney presents special challenges to
the endourologist. SWL monotherapy in the prone position results
in mixed stone-free rates of 25-92%. PNL is risky due to associated
anomalies in the renal vasculature. Percutaneous access to an upper
calyceal stone can produce a pneumothorax, hydrothorax or hemothorax
in 3% of patients. Karlin and Smith have described a technique by
which a kidney is torqued in a caudal direction with a sheath in
the middle pole calyx while a second sheath is introduced into an
RF. Extracorporeal shock-wave lithotripsy monotherapy in renal pelvic
ectopia. Urol 1996, 48:6:857-861.
GS, Smith AD: Approaches to the superior calyx: Renal displacement
technique and review of options. J Urol 1989, 142:774-777.