title: Techniques for fluoroscopic percutaneous renal access.
abstract: OBJECTIVE
  Percutaneous nephrolithotomy has undergone considerable evolution since its introduction in the 1970s, which has been driven by advances in access techniques, instrumentation and endoscopic technology. Recent reports suggest an increase in the number of percutaneous stone treatments being performed. However, despite the increasing use of percutaneous nephrolithotomy a minority of urologists obtain their own access. We reviewed the techniques for performing safe and effective percutaneous renal access.
  
  
  METHODS
  A literature search using Entrez PubMed was performed. All relevant literature concerning techniques for fluoroscopic percutaneous renal access published within the last 20 years was reviewed.
  
  
  RESULTS
  The success of percutaneous nephrolithotomy is critically dependent on achieving suitable percutaneous access. The ideal site of percutaneous puncture should be selected to maximize the use of rigid instruments, minimize the risk of complications and attain stone-free status. Familiarity with basic renal anatomy is essential to obtain access safely. Adherence to basic principles allows the establishment of percutaneous access in a straightforward and efficient manner. Certain clinical situations may require special access techniques.
  
  
  CONCLUSIONS
  Percutaneous nephrolithotomy is the treatment of choice for complex stone disease. While the efficacy of percutaneous nephrolithotomy relies on the establishment of effective percutaneous access, there are considerable advantages for the urologist able to achieve access.
authors.affiliation: Methodist Hospital Institute for Kidney Stone Disease, Indiana University School of Medicine and International Kidney Stone Institute, Indianapolis, Indiana 46202, USA.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Miller
authors.forename: Brian R
authors.initials: BR
authors.lastname: Matlaga
authors.forename: James E
authors.initials: JE
authors.lastname: Lingeman
mesh_terms: D002404:Catheterization; D004240:Diverticulum / Q000601:surgery; D005471:Fluoroscopy; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000601:surgery*; D007674:Kidney Diseases / Q000601:surgery; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D011677:Punctures / Q000379:methods; D014463:Ultrasonography