INTRODUCTION: The purpose of the study was to determine the success of a teaching method for junior urologists who were learning to puncture a calyx for percutaneous nephrolithotripsy (PCNL) under fluoroscopic guidance.
METHODS: The participants were 4 junior urologists who had never performed a complete PCNL puncture on their own. There were 22 patients with kidney stones, ranging in age from 28-52 years. The procedure was conducted by 1 junior urologist while being guided verbally by the senior physician. A needle was placed on the skin where its trajectory hit the desired calyx in the 0o and 30o planes under fluoroscopy. The needle was advanced in successive 1 cm increments. Its position was checked after each step. Any deviation from the correct path in either plane was detected early and corrected, until the desired calyx was reached in both planes simultaneously. Success of the teaching technique was determined by how often the senior physician needed to intervene. Success of the surgery was determined by its outcome, including the need for needle reinsertion and presence of complications.
RESULTS: Each surgery was performed independently by the junior urologist, with no senior physician intervention aside from verbal guidance. Successful puncture of the desired calyx was achieved during the first trial in 17 patients (77%); the needle had to be reinserted 1 or more times to attain proper direction in 5 patients (23%). Complications were blood transfusion (n = 1) and prolonged urine leakage after postoperative removal of the nephrostomy tube (n = 2).
CONCLUSION: Step-by-step advancement of the needle is a simple, accurate way to gain access to pelvicalyceal system. Junior urologists are spared the frustration that they might have after repeated failure to gain access to the kidney with other techniques.
KEYWORDS: Step-by-step instruction; Pelvicalyceal system puncture; Fluoroscopy.
CORRESPONDENCE: Yehya Hassan Elshebiny MD, Division of Urology, Department of Surgery, Adan Hospital, Fahaheel, PO Box 46496, Kuwait, 64015, Kuwait ( ).
CITATION: UroToday Int J. 2010 Aug;3(4).
doi:10.3834/uij.1944-5784.2010.08.04