Presentation
Percutaneous nephrolithotomy for removal of kidney stones
Patient Data
Multiple calculi in the left kidney, centered on the renal pelvis.
No ureteric calculi.
Intraoperative imaging illustrating the steps of a nephrolithotomy procedure.
- insertion of the percutaneous nephrolithotomy needle
- insertion of the guide wire
- insertion of the dilator
- insertion of the working sheath
On the lower pole puncture images, prior to scope insertion, the large pelvis stone is shown as a filling defect.
Percutaneous drainage tube overlies the left side of the abdomen.
Renal calculi are not perceptible on plain radiography due to marked overlying fecal residue and bowel shadows which obscure the kidneys.
Post left PCNL
Tiny 2 mm residual calcific fragment within a lower pole calyx.
The large pelvis stones are no longer evident. Left hydronephrosis and perinephric stranding likely secondary to treated obstruction.
Case Discussion
Percutaneous nephrolithotomy (PCNL) is a surgical procedure for the extraction of large renal calculi. It is usually performed in the operating theater 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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