Performing easy prone punction

How can I get a renal access if I do not have an ultrasound and cannot opacify the collecting system? Another use of the hydrophilic guide wire

It is well-known that fluoroscopic guidance is the most commonly used imaging technique for percutaneous access to the kidney. However, we might encounter difficulties when attempting to establish the limits of the collecting system for a percutaneous puncture, especially in places where the use of ultrasound guidance in the operating room is limited. We aim to describe the use of a hydrophilic guide wire to delimit the collecting system when this becomes difficult with conventional techniques.

Prone percutaneous nephrolithotomy: its advantages and our technique for puncture

Percutaneous nephrolithotomy (PCNL) is considered the treatment of choice for large urinary calculi and staghorn lithiasis. The approach for this surgery may be either supine or prone, and different access techniques are described in the literature with the use of ultrasound, fluoroscopy, or both combined. We believe that prone PCNL offers to the urologist key advantages, such as the possibility of puncturing anatomically abnormal urinary tracts, to perform multiple percutaneous tracts in the same kidney, experiencing the vacuum cleaner effect, ease of exploring the upper calyx through the inferior calyx, possibility to perform endoscopic combined intrarenal surgery (ECIRS) and bilateral simultaneous surgery, and to performed over local anesthesia. An adequate training for the endourologist should include both the prone and supine techniques for PCNL and to know which patient can benefit the most from each one.