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Percutaneous nephrolithotomy

Case contributed by Andrew Murphy
Diagnosis certain

Presentation

Percutaneous nephrolithotomy for removal of kidney stones.

Patient Data

Age: 65 years
Gender: Male

Pre operative imaging

x-ray

2cm left renal pelvic stone.

No ureteric stone.

4cm radio-opacity projected over the midline of the pelvic, likely a bladder stone.

Pre-operative CT-KUB performed elsewhere.   Not available.

Intraoperative imaging

x-ray

The steps of a PCNL are illustrated from retrograde access into the left kidney, to renal collecting puncture through to wire and sheath insertion with track dilatation and then nephroscope insertion to allow for nephrolithotomy.

Post operative study

ct

Post procedural nephrostomy tube insertion.

No residual renal or ureteric calculi.

Incidental small right inguinal hernia.

Case Discussion

Percutaneous nephrolithotomy (PCNL) is a surgical procedure for the extraction of large renal calculi. It is usually performed in the operating theatre either by a urologist or combined urologist-radiologist team.

This case is to illustrate the typical imaging pathway of a percutaneous nephrolithotomy, including the images intra-operatively.

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