Procedures increasing the effectivity of percutaneous nephrolithotomy.

The advantages of percutaneous nephrolithotomy are reviewed and the difficulties are pointed out. During more than 100 successful nephrolithotomies it was found that stones or their fragments often drift away during manipulation into lateral or upper calices which cannot be visualized by a rigid nephroscope. Thus, removal of calculi was possible only by an auxiliary manipulation and so it took more time. To prevent this, an occlusive catheter was introduced, simultaneously with the ureteral catheter, into the renal cavital system and by blocking the balloon, the orifice of the calices was closed. In the case of multiple stones, two calices were simultaneously punctured and the two nephroscopes introduced were alternately applied during ultrasonic crushing of the stone, depending on which of the two instruments was closer. The modifications introduced by the author have significantly reduced the time of the operation and increased the effectivity of the procedure.