Directive puncture of the renal collecting system during mini-percutaneous nephrolithotripsy in the supine position

BACKGROUND: Percutaneous nephrolithotripsy is the main surgical method for removing large renal calculi. One of the key stages of the procedure is percutaneous access to the renal collecting system. Retrograde contrast administration is not always required for a successful renal puncture.

AIM: The work aimed to evaluate the efficacy, indications, and contraindications of directive puncture of the renal collecting system.

METHODS: The study was conducted from January 2020 to August 2022. It included 90 patients who underwent percutaneous nephrolithotripsy in the supine position. Patients were divided into two groups. Group A underwent an ultrasound- or fluoroscopy-guided renal collecting system puncture; Group B had a puncture using retrograde ureteropyelography. Intra- and postoperative parameters were assessed, including total operation time, puncture duration, puncture success rate, visualization, puncture technique, and drainage type.

RESULTS: The groups were statistically homogeneous except for body mass index, which was higher in Group B (p = 0.0441) but did not affect the study outcome. There were no significant differences in puncture duration (p = 0.378) or visualization quality (p = 0.8221). Six hours after surgery, pain intensity was higher in the directive puncture group (p = 0.0422), whereas other pain and complication parameters did not differ between groups. Hemoglobin levels were lower in the directive puncture group (p = 0.0109) but remained within the normal range.

CONCLUSION: Directive puncture is a safe technique that is not inferior to the conventional method involving preliminary ureteral catheterization. However, it requires surgical experience and is unsuitable for patients with radiolucent calculi when performing fluoroscopy-guided punctures or in the absence of renal collecting system dilatation when performing ultrasound-guided punctures.