title: Combined percutaneous and retrograde approach to staghorn calculi with application of the ureteral access sheath to facilitate percutaneous nephrolithotomy.
abstract: OBJECTIVE
  We describe our technique and clinical experience with application of the ureteral access sheath for single access ablation of staghorn and partial staghorn calculi.
  
  
  METHODS
  We retrospectively reviewed our experience with 9 patients who underwent percutaneous nephrolithotomy for staghorn (6) or partial staghorn (3) renal calculi using a combined antegrade and retrograde approach. Patient data, operative parameters, efficacy of stone ablation and convalescence parameters were reviewed.
  
  
  RESULTS
  Mean operative time for the primary procedure was 3.1 hours with a mean estimated blood loss of 290 ml. Postoperatively, the mean analgesic requirement was 33.2 mg. MSO(4) equivalents. Hospital stay was 3.2 days. There were no major and 4 minor (44%) complications. No patient required transfusion. Complete stone clearance was achieved in 7 of the 9 cases (78%) using a single percutaneous nephrostomy tract.
  
  
  CONCLUSIONS
  Our preliminary clinical experience using the ureteral access sheath during percutaneous nephrolithotomy for simultaneous antegrade and retrograde stone treatment has been favorable. A large renal stone burden can be successfully managed with a single percutaneous access and limited blood loss.
authors.affiliation: Division of Urology, Department of Radiology, Mallinkrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Venkatesh
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.forename: Jamil
authors.initials: J
authors.lastname: Rehman
authors.forename: Maged
authors.initials: M
authors.lastname: Ragab
authors.forename: Michael
authors.initials: M
authors.lastname: Darcy
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
mesh_terms: D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D007902:Length of Stay; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy; D011183:Postoperative Complications; D015641:Radiography, Interventional; D012189:Retrospective Studies; D014513:Ureter; D014546:Urinary Catheterization / Q000379:methods*