Uribe Carlos A, Osorio Hugo, Benavides Johana, Martinez Carlos H, Valley Zachary A, Kaler Kamaljot S
Division of Urology, Hospital Pablo Tobón Uribe, Medellín, Colombia.
Department of Urology, Clínica CES, Medellín, Colombia.
J Endourol Case Rep. 2019 Aug 30;5(3):131-136. doi: 10.1089/cren.2018.0079. eCollection 2019.
Percutaneous nephrolithotomy (PCNL) serves as the gold standard minimally invasive procedure to remove large renal stones. The puncture is made from the skin to the chosen calix under fluoroscopic guidance, although this remains a challenging technique. We describe the initial case of retrograde holmium laser acquired nephrostomy access. In this study, we present the case of a 48-year-old woman with right renal colic with imaging revealing a 2.6 cm staghorn stone. With institutional approval, we performed a new technique utilizing retrograde access with a flexible ureteroscope and a holmium laser fiber to achieve nephrostomy access for PCNL in the prone position. With the ureteroscope confirmed in the desired calix, the ureteroscope and laser fiber were aimed and fired toward the flank and thus creating a subcostal nephrostomy tract. PCNL was then carried out per standard of care lithotripsy techniques utilizing the holmium laser. In this initial case, percutaneous retrograde laser access allowed for desired caliceal nephrostomy access under direct vision.
经皮肾镜取石术（PCNL）是去除大型肾结石的金标准微创手术。穿刺是在荧光镜引导下从皮肤穿至选定的肾盏，尽管这仍是一项具有挑战性的技术。我们描述了首例逆行钬激光获得性肾造瘘通路的病例。在本研究中，我们报告了一例48岁患有右侧肾绞痛的女性病例，影像学检查显示有一枚2.6厘米的鹿角形结石。经机构批准，我们实施了一项新技术，利用可弯曲输尿管镜和钬激光光纤进行逆行通路，以便在俯卧位为PCNL建立肾造瘘通路。在输尿管镜进入所需肾盏后，将输尿管镜和激光光纤对准并朝侧腹发射，从而形成一个肋下肾造瘘通道。然后按照标准的碎石技术使用钬激光进行PCNL。在这例首例病例中，经皮逆行激光通路使在直视下获得所需的肾盏肾造瘘通路成为可能。
