Birowo Ponco, Raharja Putu Angga Risky, Putra Harun Wijanarko Kusuma, Rustandi Reginald, Atmoko Widi, Rasyid Nur
Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta 10430, Indonesia.
Res Rep Urol. 2020 Jul 23;12:287-293. doi: 10.2147/RRU.S259941. eCollection 2020.
X-ray-free ultrasound-guided percutaneous nephrolithotomy (PCNL) has been proven to be safe, feasible, and affordable. Kidney dilatation during X-ray-free ultrasound-guided PCNL is mostly using balloon dilators. This report presents our experience of performing X-ray-free ultrasound-guided PCNL in supine position using Alken metal telescopic dilators in a patient with a large kidney stone. A 50-year-old male presented with right complete staghorn stone sized 46×30×24 mm (stone burden: 50,985 mm with sphere formula) and grade II hydronephrosis. The computed tomography (CT) scan showed no right ureteric stone, kinking, or stenosis. Ureteral catheter and guidewire were placed retrogradely under ultrasound guidance during cystoscopy. Normal saline was pumped via the ureteral catheter to make artificial hydronephrosis thus assisting the process. Kidney dilatation was performed with Alken metal telescoping dilators. Urine flow from the dilators confirmed that our dilator had reached the collecting system. The stone was identified and fragmented with combination of both pneumatic and shock pulse lithotripter. Double J stent and nephrostomy tubes were inserted at the end of the procedure. All of the steps were performed purely under ultrasound guidance. There was no residual stone after the procedure, confirmed by ultrasound, nephroscope, and postoperative X-ray. There was no significant complication during or after the procedure. The patient was discharged on postoperative day two. X-ray-free ultrasound-guided PCNL in supine position using Alken metal telescoping dilators seems to be a feasible, safe, and cost-effective approach in managing kidney stones, including staghorn and large stones.
无X线超声引导经皮肾镜取石术（PCNL）已被证明是安全、可行且经济实惠的。在无X线超声引导的PCNL术中，肾脏扩张大多使用球囊扩张器。本报告介绍了我们在一名患有巨大肾结石的患者中，使用Alken金属伸缩式扩张器在仰卧位进行无X线超声引导PCNL的经验。一名50岁男性，右肾完全鹿角形结石，大小为46×30×24mm（结石负荷：采用球体公式计算为50,985mm），合并II级肾积水。计算机断层扫描（CT）显示右输尿管无结石、扭曲或狭窄。在膀胱镜检查期间，于超声引导下逆行放置输尿管导管和导丝。通过输尿管导管注入生理盐水以制造人工肾积水，从而辅助手术过程。使用Alken金属伸缩式扩张器进行肾脏扩张。扩张器中有尿液流出，证实我们的扩张器已到达集合系统。识别结石后，联合使用气压弹道碎石机和超声弹道碎石机将结石击碎。手术结束时插入双J支架管和肾造瘘管。所有步骤均在纯超声引导下进行。术后经超声、肾镜及术后X线检查证实无残留结石。手术期间及术后均无明显并发症。患者术后第二天出院。使用Alken金属伸缩式扩张器在仰卧位进行无X线超声引导PCNL似乎是一种治疗肾结石（包括鹿角形结石和巨大结石）的可行、安全且经济有效的方法。
