Percutaneous Nephrolithotomy Puncture and Tract Dilation: Evidence on the Safety of Approaches to the Infundibulum of the Middle Renal Calyx

• Published in: Urology (Ridgewood, N.J.) N.J.), 2017-09, Vol.107, p.43-48
• Main Authors: Kallidonis, Panagiotis, Kalogeropoulou, Christina, Kyriazis, Iason, Apostolopoulos, Dimitrios, Kitrou, Panagiotis, Kotsiris, Dimitrios, Ntasiotis, Panteleimon, Liatsikos, Evangelos
• Format: Article
• Language: English
• Subjects: Adult; Dilatation; Female; Humans; Kidney Calculi - diagnosis; Kidney Calculi - therapy; Kidney Calices - diagnostic imaging; Kidney Calices - surgery; Male; Middle Aged; Multidetector Computed Tomography - methods; Nephrolithotomy, Percutaneous - methods; Punctures - methods; Single Photon Emission Computed Tomography Computed Tomography - methods; Treatment Outcome; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2017.05.038

Abstract Objectives To investigate the anatomical relations of the papillary, infundibular and pelvic approach to percutaneous nephrolithotomy (PCNL) and evaluate the amount of vascularization at the respective sites. Materials99m Tc-dimercaptosuccinic acid SPECT/CT renal scintigraphies or Computerized tomographies perfusion (CTP) were performed in 40 patients (prone n=20 or supine position n=20). The angle of approach (AoA) for access tracts the respective regions of interest (ROIs) to the mid-calyceal papilla and infundibulum as well as renal pelvis were designed and compared. Results The design of access tracts aiming to the renal pelvis, papilla and infundibulum of the renal calyx was impossible for the non-dilated collecting systems since all these tracts were in close vicinity. In both SPECT/CT and CTP, there was no statistical difference between the AoA for infundibular or pelvic access in comparison to the papillary puncture in either prone or supine position regardless of the degree of dilation of the system. The comparison of the measurements in the ROIs showed that there was no difference in blood supply between the infundibular or pelvic access in comparison to the papillary approach in both positions regardless to the degree of collecting system dilation. Conclusion The use of SPECT CT and CTP showed that the punctures to the mid-calyceal renal papilla-fornix and infundibulum as well as the renal pelvis at the same level have similar AoA. The sites of the parenchyma involved in the tract dilation of the respective approaches are not related with significant differences in terms of vascularization.