Abstract
We report a preliminary case of transurethral lithotripsy-assisted percutaneous nephrolithotomy (TUL-assisted PNL) (dual Ho:YAG laser lithotripsy) that was performed in a flank position via one 18Fr. nephrostomy and the 15Fr.ureteral access sheath. The patient was positioned with the stone-containing side superior. The complete staghorn calculus (70mm×36mm×18mm) in the left kidney was successfully treated with ureteroscopes passed antegrade and retrograde and Ho:YAG laser lithotriptor. As 2 light sources and laser lithotriptors were available, stone ablation was expedited by simultaneous retrograde ureteroscopic laser ablation via the ureteral sheath. The bleeding volume was 120ml. Second look percutaneous nephrolithotomy is performed the 6th postoperative day in the standard manner. The complete staghorn calculus was removed completely 3 months after operation without incurring any adverse side effect. Long operative time (445 min.) could be overcome with timesaving innovation including double irrigation system.
Application of the ureteral access sheath during percutaneous nephrolithotomy improved renal access, then, allowing the endourologist to unite the upper and lower urinary tract. The complete staghorn calculus can be successfully managed with a single percutaneous, uretreral access and limited blood loss by TUL-assisted PNL (dual Ho:YAG laser lithotripsy).
