Retrograde Nephrostomy and Percutaneous Calculus Removal in 30 Patients

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Abstract
A new technique, retrograde nephrostomy was used to provide intrarenal access for percutaneous calculus removal in 30 consecutive patients. Under fluoroscopic control, a 5F and 9F coaxial catheter pair was maneuvered cystoscopically over a guide wire into the calix selected for nephrostomy. A sheathed 20-21 gauge needle was passed through the 9F catheter into the flank to create the nephrostomy. Eight patients were given general and 22 i.v. sedation and local anesthesia for nephrostomy placement and calculus removal. Retrograde nephrostomy and subsequent calculus removal were completed successfully in 90 and 83% of the 30 patients, respectively. There were 6 complications and 3 failures among the 1st few patients due to inferior equipment and inexperience with the technique. Overall, retrograde nephrostomy provided reliable, precise intrarenal access; it may become an alternative technique to aid in percutaneous calculus removal procedures.