title: Colon Radiological Delineation Technique Prior to Percutaneous Nephrolithotomy in Patients With Horseshoe Kidney.
abstract: OBJECTIVE
  To develop a technique that helps avoid colonic injury during percutaneous nephrolithotomy (PCNL) in these patients.
  
  
  METHODS
  PCNL was prospectively performed in a cohort of adults with renal stones in a horseshoe kidney (HSK). PCNLs were done using a standardized technique in prone position in all patients. The colon was radiologically delineated by injecting air-through a catheter in the anal canal-to help localize its position in relation to the pelvicalyceal system (PCS). Patients were observed in hospital for 48 hours postoperatively to detect any potential complications related to the PCNL or to the colon insufflation modification.
  
  
  RESULTS
  Thirteen adult patients (11 men and 2 women) with renal stones in a HSK were included in the study. The colon was well radiologically delineated with air in all cases. The PCS was successfully accessed, subcostally, with a single access at the upper calyx in 11 cases and multiple accesses in 2 cases. The colon was in the way of the puncture in 2 cases in which we used a more medial access and the colon was successfully avoided. Stones were completely removed during the PCNL in 11 of the 13 cases (84.6%). One case necessitated intraoperative blood transfusion. No other complications were reported by any of the patients who were discharged home after 48 hours.
  
  
  CONCLUSIONS
  Colonic radiological delineation technique is helpful in accessing the PCS quickly, saving the colon, and causing no discomfort to patients with renal stones in a HSK.
authors.affiliation: Department of Urology, Sohag University Hospital, Sohag, Egypt. Electronic address: Saadwael738@gmail.com.
authors.forename: Wael
authors.initials: W
authors.lastname: Gamal
authors.affiliation: Department of Urology, Sohag University Hospital, Sohag, Egypt.
authors.forename: Essam
authors.initials: E
authors.lastname: Moursy
authors.affiliation: Department of Urology, Sohag University Hospital, Sohag, Egypt.
authors.forename: El Nisr
authors.initials: el N
authors.lastname: Rashed
authors.affiliation: Department of Urology, Sohag University Hospital, Sohag, Egypt.
authors.forename: Mmdouh
authors.initials: M
authors.lastname: Ahmed
authors.affiliation: Department of Urology, Sohag University Hospital, Sohag, Egypt.
authors.forename: Fawzy
authors.initials: F
authors.lastname: Farag
mesh_terms: D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000379:methods; D003106:Colon / Q000000981:diagnostic imaging*; D005260:Female; D000069337:Fused Kidney / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009403:Nephrostomy, Percutaneous; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult