The Inflated Urobag Technique for Accessing the Pelvicalyceal System during Prone Percutaneous Nephrolithotomy in a Ptotic Kidney PR01-PR02
Dr. Suresh Bhat,
Professor, Department of Urology, Government Medical College, Kottayam, Kerala, India.
Percutaneous Nephrolithotomy (PCNL) is a common endourologic procedure done for removal of renal stones. The most important initial step involves making a safe puncture into the pelvicalyceal system, and establishing an access tract into pelvicalyceal system. This is a crucial step in the success of the PCNL. Though the procedure is relatively simple and straight forward, in conditions like hyper-mobile kidney or ptotic kidney, the pelvicalyceal system is abnormally oriented and the kidneys are excessively mobile making the puncture of pelvicalyceal system difficult. Till date there is no established technique to overcome this problem. The technique of resolving this problem involved placing an air filled urobag beneath the patient in the prone position on the ipsilateral side of abdomen. This technique of placing an inflated urobag called as â€śThe inflated urobagâ€ť technique is a simple one, which relocates the kidney and hence the pelvicalyceal system to normal anatomical position, making the initial puncture easier. This also prevents excessive mobility of the kidney during puncture and dilatation of the tract. This technique, which is not described earlier, is extremely useful in the puncture and dilatation during prone PCNL in ptotic and hyper-mobile kidneys. We here in describe our experience in 15 cases of PCNL in ptotic or hypermobile kidney.