title: Ultrasound - guided access during percutaneous nephrolithotomy: entering desired calyx with appropriate entry site and angle.
abstract: OBJECTIVE
  To evaluate the success of ultrasonography directed renal access in entering the target calyx from proper entry site and in the direction of renal pelvis during percutaneous nephrolithotomy (PCNL).
  
  
  METHODS
  PCNL cases who were operated on by one fellow from May-June 2014 were included in this study. A vertically placed ultrasound probe on the patient flank in prone position was used to identify the preselected target calyx. Needle was advanced through needle holder and fluoroscopy was used to document the entered calyx, site and angle of entry.
  
  
  RESULTS
  Successful entering to the target calyx was achieved in 43 cases (91%). Successful entry with appropriate entry site and angle was observed in 34 cases (72%). Reasons for failure were minimal hydronephrosis, upper pole access and high lying kidneys.
  
  
  CONCLUSIONS
  Although it is feasible to access a preselected calyx by ultrasonography guidance during PCNL, but entry to the calyx from the appropriate site and direction is another problem and needs more experience. In cases of minimal hydronephrosis, superior pole access or high lying kidneys, ultrasonography is less successful and should be used with care.
authors: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Abbas
authors: A
authors: Basiri
authors: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.|Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran.
authors: Amir H
authors: AH
authors: Kashi
authors: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Mehdi
authors: M
authors: Zeinali
authors: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Mahmoodreza
authors: M
authors: Nasiri
authors: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Reza
authors: R
authors: Sarhangnejad
authors: Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors: Reza
authors: R
authors: Valipour
mesh_terms: D000328:Adult; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009339:Needles; D009403:Nephrostomy, Percutaneous / Q000379:methods*; D016684:Prone Position; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Nephrostomy, Percutaneous; Ultrasonography