Percutaneous Stone Removal Using a Combined Retrograde-Antegrade Access Technique

Nineteen patients had percutaneous nephrostomy tubes placed using a new combined retrograde-antegrade (RG-AG) technique. Percutaneous nephrolithotomy was planned in 16 patients. With the patient in a lithotomy position, a 7-Fr. end-hole ureteral catheter is advanced cystoscopically into the renal pelvis and fluoroscopically manipulated into a pre-selected calyx using a 5-Fr. cobra catheter and a 0.035-inch Bentson or torque wire. A wire basket is deployed in the appropriate calyx, but left housed within the guiding catheter. A Foley catheter is placed, and the patient is rotated into the prone position. A special blunt 18-guage splenic needle is then used to perform the puncture fluoroscopically. The needle is advanced through the renal parenchyma into the targeted calyx, and the obturator is removed. The previously-positioned ureteral catheter is withdrawn allowing the basket to form in the distal calyx. Next, a 22-guage Hawkins needle guide is inserted through the 18-guage needle and projected through the basket. The needle obturator is exchanged for a 0.018-inch J wire which is advanced out past the needle tip. The 22-guage needle is then retracted leaving the guide wire in place. The basket is withdrawn into the ureteral catheter and the wire is pulled out through the urinary tract securing RG-AG access. Tract dilation is performed in a standard fashion.