Introduction and Objectives
The aim of this article is to introduce our initial experience in ultrasound guided percutaneous lithotripsy.
Material and Methods
From september 2008 to june 2009, we performed this procedure on 18 patients with massive renal calculosis, who had failed previosly combined retrograde intrarenal lithotripsy and ESWL. Our decision to use this access instead of radiological was influenced with lack of conditions on our department for latter. Twelve patients were in standard lumbotomy position and 4 patients were in modified supine positon. Before each procedure, we placed ureteral catheter Ch 5 in ipsilateral ureter for arteficial dilatation of pyelocaliceal system and for protective drainage during postoperative care. After introducing puncture needle through dilatated calices, we continued with placement of guidewire, than ballon dilatator (COOK-which were insuflated on 18 mm Hg) or we used telescopic dilatators for making a working chanell. After this procedure we introduced Amplatz and finally nefroscope Ch 28(Olympus). Lithotripsies were performed with pneumatic lithotriptor, using lithovac aspiration and several kind of forcepses.
Average duration of procedures were about 130 minutes. In 16 patients we had complete desintegration and extraction of fragments. In 2 patients we could not reach calices and calculi. There were no need for blood transfusions or conversion to open procedures. In 2 patients we had intraperitoneal brekthrough of irrigation fluid, which was evacueted by peritoneofix. We left Foley catheter Ch 18 as a nephrostomy tube in all patients. We did not have major early or late complications in other 14 patients.
Ultrasound guided percutaneous lithotripsy is feasible, reproducibile, safe and acceptible for urologist because there is no risk of x-ray adverse effects, but very demanding. Urologist must be patient and skilled in ultrasound percutaneous and endourological procedures.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.