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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2015; 3(3): 245-264
Published online Mar 16, 2015. doi: 10.12998/wjcc.v3.i3.245
Fluoroscopy guided percutaneous renal access in prone position
Gyanendra R Sharma, Pankaj N Maheshwari, Anshu G Sharma, Reeta P Maheshwari, Ritwik S Heda, Sakshi P Maheshwari
Gyanendra R Sharma, Department of Urology, Chitale Clinic Private Limited, Solapur, Maharashtra 413001, India
Pankaj N Maheshwari, Reeta P Maheshwari, Ritwik S Heda, Sakshi P Maheshwari, Fortis Hospital Mulund, Maharashtra 413001, India
Anshu G Sharma, Department of Radiology, Chitale Clinic Private Limited, Solapur, Maharashtra 413001, India
Author contributions: All the authors were involved in the collection of data, analyzing it, preparing the manuscript and revising it and have seen the final version of the article.
Conflict-of-interest: The authors declare that they have no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Gyanendra R Sharma, MS, MCh, DNB, Department of Urology, Chitale Clinic Private Limited, 165 D Railway Lines, Solapur, Maharashtra 413001, India. drgrsharma@gmail.com
Telephone: +91-217-2319251 Fax: +91-217-2319253
Received: July 27, 2014
Peer-review started: July 27, 2014
First decision: September 17, 2014
Revised: September 24, 2014
Accepted: November 27, 2014
Article in press: November 27, 2014
Published online: March 16, 2015
Processing time: 229 Days and 3 Hours
Abstract

Percutaneous nephrolithotomy is a very commonly done procedure for management of renal calculus disease. Establishing a good access is the first and probably the most crucial step of this procedure. A proper access is the gateway to success. However, this crucial step has the steepest learning curve for, in a fluoroscopy guided access, it involves visualizing a three dimensional anatomy on a two dimensional fluoroscopy screen. This review describes the anatomical basis of the renal access. It provides a literature review of all aspects of percutaneous renal access along with the advances that have taken place in this field over the years. The article describes a technique to determine the site of skin puncture, the angle and depth of puncture using a simple mathematical principle. It also reviews the common problems faced during the process of puncture and dilatation and describes the ways to overcome them. The aim of this article is to provide the reader a step by step guide for percutaneous renal access.

Keywords: Fluoroscopy; Percutaneous renal access; Percutaneous nephrolithotomy; Learning curve; Kidney

Core tip: This article is a review of the various fluoroscopic guided renal access techniques. It provides an in depth description of the technique with the aim that the urologist can have a step by step guide of the procedure. It gives an anatomical basis of percutaneous renal access and gives description of determining the skin site, angle and depth of puncture. It also describes the difficulties faced and incorporates suggestions to prevent and overcome them.