Percutaneous nephrostomy--techniques.
Percutaneous nephrolithotripsy has become a widely accepted procedure, that permits the removal of up to 90% of all renal calculi with minimal morbidity and success rates of over 95%. Together with extracorporeal shock wave lithotripsy and the introduction of the ureterorenoscope it has revolutionised the surgical therapy of this clinical entity, and has reduced the need for open surgical interventions to approximately 5% of the numbers required before these methods became available. The success of percutaneous endoscopic surgery depends mainly on the correct position of the percutaneous nephrostomy, which must provide access to all renal calculi via a straight tract, yet should avoid significant trauma to the kidney or perirenal structures. This situation differs from the requirements for simple drainage of obstructed kidneys, as the collecting system of stone bearing kidneys is usually not dilated and the tract has to be adapted to the specific anatomical situation. Special techniques and material have been developed to meet these demands. The purpose of this article is to present our approach, based on percutaneous nephrolithotripsy in 2100 reno-ureteral units. Special reference is given to difficult anatomic situations, which frequently result in failure in inexperienced hands.