PCNL IN

ECOTOPIC
KIDNEY
Presented by Dr Pradeep Sharma
Ectopic Kidney
2 Types

Simple renal Ectopia

Proper side
Abnormal position
Cross Renal Ectopia
PCNL - the perfect punture in ectopic kidney
What is a perfect puncture?

• Allows easiest access to the stone, lithotripsy and

complete stone clearance

• Minimal risk of injury

avoid major vessels, bowel, lungs
Shortest distance may not be best
Minimize injury to kidney

Decrease risk of
End on puncture of Along axis of calyx,
injury to segmental
the calyx leading into
vessels, calyceal
infundibulum
perforation or tear
Obtaining a good puncture

Planning the puncture

Opacification of collecting system
Technique of puncturing
Special situations - non opacified system,
non dilated system
Securing a good puncture and establishing a
working tract
Planning the puncture - Considerations

1. Posterior calyx Psychiatrists

2. Straightest path to calyx with highest stone burden
3. Dilated calyx
Lower, upper or mid pole?
Need to have access to upper ureter?
Single or multiple punctures?
Posterior vs anterior calyx
Only puncture on posterior
calyx
Ant/post calyx recognised
on C-arm
Anterior middle
Upper and lower poles are
usually complexes
Pure ant/post calyx in mid
pole
Ant calyx stone accessed
Posterior middle
via post calyx
End on puncture with
straightest path along
stone axis

• Puncture along stone axis

Puncture and dilate in 2 planes

AP for direction
Oblique for depth
End-on puncture
Dilate on oblique - depth appreciation
is essential
Non opacification of collecting system
Puncture to stone

Ultrasound guided
puncture
a. Direct puncture
b. Double puncture
technique
PCNL TO TREAT CALCULI IN HK
PCNL is TOC for calculi in HK > 1.5-2.0 cm, or when SWL fails.
Percutaneous access to a HK is more favorable than in normal
kidneys.
Abnormal anatomic position(lower & incomplete/non rotation of
kidneys, calyceal orientation) causes PCNL to be easier and more
safe.
ANATOMIC IMPLICATIONS OF HK
IN PCNL
The anteroposterior tilt of kidney is prominent. which
makes upper pole the most superficial and posterior
aspect of HK.
Upper pole calyces are more posterior & lateral and
often subcostal,
Convenient & relatively safe route for PCNL access.
Lower pole calyces are anterior, lie in a coronal plane,
angled medially and inaccessible percutaneously.
Standard site for PCNL puncture: Along the posterior
axillary line just caudad to 12th rib, but angle caudad
rather than cephalad.
This provides percutaneous access to Upper pole
posterior calyx: useful in HK because this is the easiest
calyx to enter, puncture is subcostal, and it provides
excellent access to most of the kidney and ureter owing
to the alignment of long axis of the moiety.

However, for stones in an isthmic location availability of

flexible nephroscope might achieve a better clearance.
Urolithiasis Case 1

•22 year male

•Pain left flank
•Dysuria
•Vomiting
CECT Report
IVP with KUB
RGP
Urolithiasis Case 2

•25 year old male

•Right renal colics
•Recurrent UTI
Urolithiasis Case 3

•45 year old female

•Pain lower abdomen
Hematuria
PRI OPerative X-Ray
Left laproscoppy guided PCNL done
THANK YOU