Percutaneous Nephrostolithotomy for Treatment of Impacted Ureteropelvic Junction Calculus
Max S. Yudovich, MD; Joseph Y. Clark, MD
Penn State Health Milton S. Hershey Medical Center

Percutaneous nephrostolithotomy (PCNL) is a minimally invasive urologic procedure used to treat large kidney stones or stones which are not accessible from a retrograde approach. When untreated, these stones can cause chronic pain, infections, and over time, decreased renal function. The indications for PCNL include total renal stone burden greater than 20 mm, lower pole stone burden greater than 10 mm, or any stone burden which cannot be treated with ureteroscopy or extracorporeal shockwave lithotripsy, such as in the setting of a ureteral stricture or ureteropelvic junction obstruction.

During the procedure, the patient is typically positioned prone, and a needle is used to puncture the kidney through the flank. As in the case of our procedure, a pre-existing nephrostomy tube can also be used. After wire access to the kidney is obtained, the tract is dilated and an access sheath is placed to facilitate irrigation and insertion of instruments. Large stones can be removed through ultrasonic lithotripsy, pneumatic (ballistic) lithotripsy, laser lithotripsy (typically holmium:YAG or thulium lasers), and combination devices that integrate ultrasonic and pneumatic mechanisms. Smaller stones, such as in our case, can be extracted using graspers. In this video, we present a left-sided PCNL in which we remove a total of 2.1 cm of renal stone burden. Following stone removal, a ureteral stent and nephrostomy tube were placed to enable maximal drainage of the kidney. Postoperative CT showed complete clearance of stone burden.