Second-look Percutaneous Nephrolithotomy: Access to the Tract with Direct Vision and Fluoroscopic Guidance

IntroductionPercutaneous nephrolithotomy (PCNL) is the preferred treatment for large kidney stones. Second-look nephroscopy is one of the methods for removing residual stone fragments after PCNL. During second-look nephroscopy, we passed a guidewire through the previously established nephrostomy tract, which was impossible in this case. Thus, we performed the procedure with direct tract ureteroscopy and simultaneous fluoroscopy. Case presentationA 45-year-old man with full staghorn calculi was the case of this study. We performed PCNL surgery on him, but because of tachycardia and a fall in the patient’s blood pressure, we terminated the surgery after 3 hours. Because of the high possibility of remaining stones, we inserted a Foley 16 catheter as a nephrostomy. A significant volume of stone residue was observed in the computerized tomography (CT) scan two days after the surgery. Four days after surgery, the patient was transferred to the operating room after improving the clinical status and resolving hematuria. The procedure occurred when the patient was in a prone position and under general anesthesia. After cutting the nephrostomy tube, the attempt to insert the wire was not successful. So, we removed the nephrostomy tube. After retrograde injection of the contrast agent and fluoroscopy, we observed the contrasting agent passage through the nephrostomy tract to the skin surface. We found the main tract with simultaneous ureteroscopy and fluoroscopy. Then insert a guidewire in the renal pelvis and nephroscopy through the wire. ConclusionsWith the help of ureteroscopy, direct vision, and fluoroscopy, we found the last tract, entered the pyelocaliceal system, and embedded the guidewire. Thus, we performed nephroscopy from the same tract site without needing re-access.