Percutaneous Renal Surgery

Contents
This History of Percutaneous Nephrolithotomy
	1 Open Stone Surgery
	2 The First Percutaneous Nephrostomy
	3 Image Guided Nephrostomy
	4 The First Percutaneous Stone Extraction
	5 The First Percutaneous Nephrolithotomy
	6 The Birth of Endourology
	7 Medical Devices for Percutaneous Nephrolithotomy
	8 Dissemination of Percutaneous Nephrolithotomy
	9 Percutaneous Nephrolithotomy Innovations
	10 Other Percutaneous Renal Procedures
	11 Conclusion
	References
Indications for PCNL Including Guidelines
	1 Introduction
		1.1 EAU Guidelines
		1.2 AUA Guidelines
		1.3 Stone Size
		1.4 Stone Composition
		1.5 Stone Location
		1.6 Anatomical Anomalies
		1.7 Calyceal Diverticular Stones
		1.8 Horseshoe Kidney
		1.9 Ectopic or Fused Kidneys
	2 Patient Factors
		2.1 Occupation
		2.2 Obesity
		2.3 Patients with Urinary Diversions
		2.4 Skeletal Anomalies
		2.5 Encrusted Foreign Objects
		2.6 PCNL in Paediatric Patients
		2.7 Future Directions for PCNL
	References
Training and Simulation Models in PCNL
	1 Section 1: Introduction
	2 Section 2: Types of Simulation
		2.1 Generic Simulation
		2.2 Physical Simulation
		2.3 Virtual Reality and Augmented Reality
		2.4 Immersive Simulation
	3 Section 3: Patient-Specific Simulation
		3.1 Augmented Reality Patient-Specific PCNL
		3.2 Patient-Specific Physical Reality Simulation
	4 Section 4: Advances for Training in PCNL Simulation
		4.1 Advances in Training-Remote Proctoring
		4.2 Advances in Training- Robotic Assistance
	References
Preoperative Patient Preparation and Imaging in PCNL
	1 Introduction
	2 Patient History
		2.1 Anticoagulation
		2.2 Contrast Allergies
		2.3 Anatomic Considerations
	3 Laboratory and Radiographic Evaluation
		3.1 Urinalysis and Urine Culture
		3.2 Laboratory Data
		3.3 Electrocardiogram and Chest X-Ray
	4 Patient Preparation
		4.1 Antibiotics
		4.2 Anesthesia
		4.3 Tranexamic Acid
	5 Imaging
		5.1 CT Imaging
		5.2 Ultrasound Imaging
		5.3 Fusion Imaging
		5.4 Advanced Imaging Modalities: Virtual Image Guidance, 3D Imaging and 3D Printed Modelling
		5.5 Skin-to-Stone Distance (SSD)
		5.6 Grading PCNL Complexity and Outcomes
		5.7 Imaging Considerations for Supine Versus Prone Percutaneous Nephrolithotomy (PCNL)
		5.8 Imaging Considerations for Size of the PCNL Tract
		5.9 Calyceal Diverticula
		5.10 Ectopic Kidney
		5.11 Paediatric Stones
	References
Anatomy of the Renal Surgery
	1 Pelviocalyceal System: Endourological Implications
		1.1 Anatomical Background
		1.2 Findings and Clinical Implications
	2 Anatomic Relationships of Intrarenal Vessels (Arteries and Veins) with the Kidney Collecting System
		2.1 I—Relevance for the Intrarenal Access by Puncture
		2.2 Material Studied for the Anatomical Background
		2.3 Intrarenal Access Through an Infundibulum
		2.4 Intrarenal Access Through the Renal Pelvis
		2.5 Intrarenal Access Through a Calyceal Fornix
	References
Positioning in Percutaneous Renal Surgery
	1 Prone Position
	2 Evolution of Patient Positioning
	3 Advantages and Drawbacks of Prone Position
		3.1 Advantages
		3.2 Drawbacks
	4 Impact of Patient Position on Outcomes for PCNL
	5 Conclusion
	6 Supine Position
	7 Evolution of Patient Positioning
	8 Benefits and Drawbacks of Supine Position
		8.1 Benefits
		8.2 Drawbacks
	References
Ultrasound Guided Access
	1 Introduction
	2 History of Ultrasound Guided Access
	3 Advantages of Ultrasound Guided Access
	4 Learning Curve
	5 Ultrasound Versus Fluoroscopy
	6 Ultrasound Guided Renal Access: Overview of Ultrasound Technology
	7 Fundamentals of Ultrasound Technology
	8 Ultrasound Terminology
		8.1 Ultrasound Modes
		8.2 Transducers
		8.3 Contrast Agents
		8.4 Echogenicity
		8.5 Attenuation
		8.6 Artifact
	9 Patient Selection
	10 Pre-operative Considerations and Patient Positioning
	11 Procedural Steps
		11.1 Adjusting User Dependent Imaging Variables
	12 Summary
	References
Radiation Hazards in Endourology
	1 Introduction
	2 Basic Principles of Medical Ionizing Radiation
	3 Health Risks of Ionizing Radiation
		3.1 Radiation Effects—Defining the Terms
		3.2 Radiation Hazards
		3.3 Exposure Limits
	4 Radiation in Stone Disease—Diagnosis and Pre-operative Use
	5 Radiation in Stone Disease—Intra-Operative Use
		5.1 Fluoroscopy Settings and Doses
		5.2 Factors Affecting Radiation Dose During PCNL
		5.3 Reducing Radiation During PCNL
	6 Radiation in Stone Disease—Follow-Up
	7 Special Populations
		7.1 Children
		7.2 Pregnancy
	8 Clinical Scenarios
	9 Summary of Key Points
	References
Percutaneous Nephrolithotomy Access Under Fluoroscopic Control (Prone and Supine)
	1 Radiation Exposure
	2 Ultrasound Versus Fluoroscopy-Guided Access
		2.1 PNL Position Variations
		2.2 PNL in Prone Position
		2.3 PNL in Supine Position
		2.4 PNL in Lateral Position
		2.5 Challenging Situations
		2.6 Dilation
	3 Conclusions
	References
Endoscopic Combined IntraRenal Surgery (ECIRS)
	1 Introduction
	2 Patient Positioning
		2.1 Galdakao-Modified Supine Valdivia (GMSV) Position and Giusti’s Position
		2.2 Prone Split Leg Position
	3 Equipment Positioning
	4 Operative Steps
	5 Versatility of ECIRS
	6 Disadvantages of ECIRS
	7 Conclusion
	References
Papillary Versus Non-papillary Puncture for Percutaneous Nephrolithotomy
	1 Introduction
	2 The Papillary Dogma
	3 PCNL as a Surgical Technique
	4 The Non-papillary Access
	5 Experimental Data
	6 Clinical Data
	7 Standard PCNL
	8 Staghorn Calculi
	9 Mini PCNL
	10 PAUL (Percutaneous Antegrade Ureterolithotripsy)
	11 ECIRS (Endoscopic Combined Intrarenal Surgery)
	12 The Comparison
	13 Conclusion
	References
Tract Dilation for PCNL
	1 Introduction
	2 Tract Dilation Under Fluoroscopic Guidance
	3 Creation of Percutaneous Tract in a Modified or Supine Position
	4 Tract Dilation Under Ultrasonographic Guidance
	5 Conclusion
	References
Mini Percutaneous Nephrolithotomy
	1 Percutaneous Access
		1.1 Metal Telescopic Dilatation (Alken Dilatation)
		1.2 Single-Step Dilatation
		1.3 Balloon Dilatation
		1.4 Sequential Amplatz Dilatation
	2 Equipment Available for Mini-PCNL
		2.1 Nephroscopy
		2.2 Lithotripsy
	3 Extraction of Fragments in Mini-PCNL
		3.1 Hydrodynamic Evacuation of Fragments
		3.2 Active Evacuation by Suction
		3.3 Baskets and Graspers
	4 Exit Strategies in Mini-PCNL
		4.1 Tubeless Mini-PCNL
		4.2 Totally Tubeless Mini-PCNL
		4.3 Tract Sealing
	5 Outpatient Mini-PCNL
	6 Mini-PCNL Versus Other Stone Treatments
	References
Ultra Mini PCNL
	1 Benefits of Miniaturization and the Development of Ultra-Mini PCNL
	2 Instruments and Technique
	3 When Is UMP Appropriate?
	4 How Does Ultra Mini PCNL Compare to Ureteroscopy and Standard PCNL?
	5 Synopsis
	References
Super-Mini-PCNL (SMP)
	1 Materials
	2 Indications and Contraindications
	3 Technique
	4 Advantages Over Other Miniaturized PCNLs
	5 Enhanced SMP (eSMP)
	6 Comment
	References
Micro PCNL
	1 Introduction
	2 Development of Armamentarium
	3 Armamentarium
	4 Technique of the Procedure
	5 Salient Features of Microperc
	6 Modification of Microperc
	7 Advantages of Microperc
	8 Disadvantages of Microperc
	9 Role of Microperc in the Era of RIRS
	10 Comparison of Microperc with SWL
	11 Comparison of Microperc with Miniperc
	12 Microperc in Today’s Scenario
	13 Conclusion
	References
Percutaneous Nephrolithotomy in Patients with Medullary Sponge Kidney
	1 Background
	2 Pathophysiology
	3 Clinical Presentation
	4 Management
	References
PCNL for Calyceal Diverticula
	1 Introduction
	2 Presentation
	3 Diagnostic Workup
		3.1 KUB
		3.2 Ultrasound
		3.3 Computed Tomography
	4 Treatment Strategies
		4.1 Extracorporeal Shock Wave Lithotripsy
		4.2 Ureteroscopy
		4.3 Laparoscopic/Robotic Approach
		4.4 Percutaneous Nephrolithotomy
	5 Steps to Percutaneous Treatment of Calyceal Diverticular Stones
		5.1 Step 1: Patient Positioning
		5.2 Step 2: Percutaneous Access
		5.3 Fluoroscopic Access
		5.4 Ultrasound Access
		5.5 Step 3: Dilation
		5.6 Step 4: Stone Extraction
		5.7 Step 5: Handling of the Diverticular Neck
		5.8 Step 6: Treatment of the Diverticular Lining
		5.9 Step 7: Drainage
	6 Complications
	7 Conclusion
	References
Percutaneous Nephrolithotomy in the Horseshoe Kidney
	1 Introduction
	2 Embryology
	3 Anatomic Considerations
	4 Stone Disease in the Horseshoe Kidney
	5 Other Surgical Management
	6 Indications for PCNL in HSK
	7 Preoperative Evaluation
	8 Operating Room Setup
	9 Patient Positioning
	10 Retrograde Injection
	11 Percutaneous Puncture
	12 Fluoroscopic Guidance
	13 Tract Dilation
	14 Nephroscopy
	15 Stone Extraction
	16 Flexible Endoscopy
	17 Exit Strategy
	18 Complications
	19 Postoperative Considerations
	20 Follow up
	21 Conclusion
	References
PCNL for Lower Pole Calyceal Stones
	1 Introduction
	2 Percutaneous Nephrolithotripsy
	3 Anatomy of the Inferior Calyx of the Kidney
	4 Overview of the Treatment of Lower Pole Calyceal Stones
	5 Indications and Results of PCNL in the Treatment of Lower Pole Calyceal Stones
	6 Technical Aspects of PCNL in the Treatment of Lower Pole Calyceal Stones
	References
Percutaneous Nephrolithotomy in Pediatric Patients
	1 Indications and Contraindications
	2 Operative Position
	3 Preoperative Preparation
	4 Surgical Procedures
	5 Operation Tips and Tricks
	6 Postoperative Management
	7 Complications and Their Prevention
	8 Recent Advances in PCNL
	9 Summary and Future Prospects
	References
Endoscopic Technology for PCNL
	1 Percutaneous Renal Endoscopy (Nephroscopy): Past to Present
	2 Future Directions and Perspectives
	References
Ancillary Devices for Percutaneous Nephrolithotomy
	1 Introduction
	2 Instruments for Access/Puncture
		2.1 Needle Holder
		2.2 Needles
		2.3 Guidewires
		2.4 Angled Catheters
		2.5 Dual Lumen Catheters
	3 Dilation Instruments
		3.1 Nephrostomy Balloon Catheter
		3.2 Amplatz Type Renal Dilator
		3.3 Peel Away Introducer
	4 Stone Extraction Instruments
		4.1 Forceps
		4.2 Basket Catheters
	5 Instruments for Preventing Complication
		5.1 Ureteral Occlusion Device
		5.2 Tamponade Balloon Device
	6 Conclusion
	References
Intracorporeal Lithotripsy Devices for PCNL
	1 Introduction
	2 Electrohydraulic Lithotripsy
		2.1 History
		2.2 Mechanism of Action
		2.3 Technique of Lithotripsy
		2.4 Advantages
		2.5 Disadvantages
		2.6 Latest Evolutions
	3 Ultrasonic Lithotripsy
		3.1 History
		3.2 Mechanism of Action
		3.3 Technique
		3.4 Advantages
		3.5 Disadvantages
		3.6 Latest Evolutions
	4 Ballistic Lithotripsy
		4.1 History
		4.2 Mechanism of Action
		4.3 Technique
		4.4 Advantages
		4.5 Disadvantages
		4.6 Latest Evolutions
	5 Combined Ultrasonic and Ballistic Lithotripsy
		5.1 History
		5.2 Two-Probe Dual-Modality Lithotripsy
		5.3 Single-Probe Dual-Modality Lithotripsy
	6 Laser Lithotripsy
		6.1 History
		6.2 Ho:YAG Laser, General Features
		6.3 Ho:YAG Laser, Mechanism of Action
		6.4 Ho:YAG Laser, Technique of Lithotripsy
		6.5 Ho:YAG Laser, Advantages
		6.6 Ho:YAG Laser, Disadvantages
		6.7 Present Developments: The Superpulse Thulium Fiber Laser
		6.8 Latest Evolutions: The Pulsed Thulium:YAG Laser
	7 Conclusions
	References
Exit Strategies in PCNL
	1 Introduction
	2 NTs: Large-Bore, Small-Bore, and Nephroureterostomy Catheter
	3 NT Versus Ureteral Stent in PCNL
	4 NT Versus Tubeless in PCNL
	5 Hemostasis Techniques and Agents in Tubeless PCNL
	6 Intraoperative Decision-Making for Appropriate Exit
	7 Summary
	References
Outpatient Percutaneous Nephrolithotomy
	1 History of Outpatient PCNL
	2 Practical Advantages and Disadvantages of oPCNL
	3 Patient Selection for Outpatient PCNL
	4 Intraoperative Considerations for Outpatient PCNL
	5 Outcomes of Outpatient PCNL
	6 Getting Started with Outpatient PCNL
	7 Future Directions in Outpatient PCNL
	8 Conclusions
	References
PCNL in Developing Countries
	1 Introduction
	2 Imaging
	3 Teaching and Training
	4 Instruments, Devices and Procedure Settings
	5 How To Perform PCNL in LMICs
	6 Complications Prevention and Management
	7 Conclusion
	References
Complications of Percutaneous Nephrolithotomy
	1 Introduction
	2 Hemorrhage
		2.1 Pre-operative Considerations
		2.2 Intraoperative Bleeding
		2.3 Postoperative Bleeding
	3 Collecting System Injury
		3.1 Perforation
		3.2 Strictures of the Ureteropelvic Junction (UPJ) and Ureter
		3.3 Infundibular Stenosis
		3.4 Retained Foreign Body
	4 Injury to Surrounding Organs
		4.1 Lung and Pleura
		4.2 Colon
		4.3 Small Intestine
		4.4 Liver, Gallbladder, Spleen
	5 Medical Complications
		5.1 Infection and Sepsis
		5.2 Fluid Overload
		5.3 Hypothermia
		5.4 Positioning-Related Injury
	6 Conclusions
	References
Intra-renal Pressure
	1 Introduction
	2 Background
	3 Measurement of IRP
	4 Physiologic IRP
	5 IRP in Percutaneous Nephrolithotomy
	6 Implications of Elevated IRP
	7 Pyelovenous Backflow
	8 Pyelosinuous Backflow
	9 Intra-Renal Backflow
	10 Pressure Injury
	11 Clinical Pearls
	12 Clinical Manifestations of Elevated IRP
	13 Fluid Absorption
	14 Inflammatory/Infectious Response
	15 Post-Operative Recovery
	16 Clinical Pearls
	17 Procedural Factors Influencing IRP
	18 Irrigation Pressure
	19 Renal Access Sheath Size
	20 Nephroscope Size
	21 Positioning of Renal Sheath and Nephroscope
	22 Ureteral Cannulation
	23 Bladder Decompression
	24 Active Irrigant Evacuation
	25 Clinical Pearls
	26 Future Directions
	27 Conclusions
	References
Percutaneous Management of Upper Tract Urothelial Carcinoma
	1 Introduction
	2 Indications and Contraindications
	3 Preoperative Evaluation
	4 Operative Details
	5 Topical Agents
	6 Outcomes
	7 Complications
	8 Surveillance
	9 Conclusions
	References