“Angular Percutaneous Renal Access”. Multiple Tracts Through A Single Incision for Staghorn Calculous Treatment in A Single Session

We herein describe the technique of a single subcostal skin incision with multiple angular punctures to approach the superior, middle and lower pole of the kidney for the management of staghorn calculi. One hundred patients with staghorn calculi were managed between January 1997 and June 2000. The superior calyx was approached by a subcostal triangulation technique and the middle and lower calyces were approached by angular punctures. Correct advancement of the needle was monitored by biplane fluoroscopy. Maximum effort was made for complete stone clearance in a single session. 87% patients were rendered stone free in a single session. The average number of tract dilation per renal unit was 2.4 with an average anesthesia time of 110 minutes and the average blood loss of 450 ml. The average hospital stay duration was 4.6 days. The secondary procedures required were 0.11 per patient and the complication rate totalled 7% with one case of excessive hemorrhage requiring embolization. We therefore propose the triangulation technique as a safe and appealing method for the percutaneous management of staghorn calculi.