X-ray-free Ultrasound-guided Percutaneous Nephrolithotomy in Supine Position Using Alken Metal Telescoping Dilators in a Large Kidney Stone: A Case Report.

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.