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Case Reports
. 2020 Jul 23:12:287-293.
doi: 10.2147/RRU.S259941. eCollection 2020.

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

Ponco Birowo  1 , Putu Angga Risky Raharja  1 , Harun Wijanarko Kusuma Putra  1 , Reginald Rustandi  1 , Widi Atmoko  1 , Nur Rasyid  1
Affiliations
Case Reports

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

Ponco Birowo et al. Res Rep Urol. .

Abstract

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 mm3 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.

Keywords: PCNL; X-ray-free; kidney stone; supine position; ultrasound-guided.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
CT scan showed right complete staghorn stone with left proximal ureteral stone.
Figure 2
Figure 2
Coronal (A) and sagittal (B) plane view of the right ureter reconstruction showed no ureteric stone, kinking, or stenosis.
Figure 3
Figure 3
The patient was placed in modified-lithotomy position. The left leg was in lithotomy position, while the right leg was abducted as laterally as possible.
Figure 4
Figure 4
(A) Appearance of ureteral catheter (arrow) in collecting system during insertion; (B) Water jet appearance (arrow) when normal saline was flushed from the ureteral catheter.
Figure 5
Figure 5
During puncture and stone fragmentation, the right leg was returned to the center to avoid disturbance of puncture site and limitation of nephroscope movement.
Figure 6
Figure 6
Ultrasound showed the tip of puncture needle (arrow) had reached the target calyx.
Figure 7
Figure 7
Irrigation solution that were pumped via the ureteral catheter increased the collecting system visualization and prevented stone fragments migration.
Figure 8
Figure 8
The stone was visualized with 30 Fr rigid nephroscope (A) and fragmented with combination of pneumatic and shock pulse lithotripters (B). There was no residual stone after the PCNL procedure (C).
Figure 9
Figure 9
(A) Evacuated stone fragments during the procedure; (B) Postoperative KUB photo showed no residual stone in the right kidney with correctly positioned DJ stent.
None
See this image and copyright information in PMC

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