Ultrasound-fluoroscopy guided access to the intrarenal excretory system

The access to the collecting system can be performed under fluoroscopy comp uterized tomography, ultrasonographic, mixed ultrasonographic and fluorosco pic guidance. In this paper the creation of a percutaneous transparenchymal ultrasound-fluoroscopy guided access to the intrarenal collecting system c ompletely performed by urologist for different purposes is presented. In fi ve years 297 patients underwent 330 percutaneous kidney accesses to perform derivative nephrostomies (217 pts), percutaneous nephrolithotomies (37 pts ), antegrade ureteral manoeuvres (34 pts), antegrade endopyelotomies (7 pts ), transitional cell carcinoma of the upper tract resection (2 pts). 11 pat ients out of these had a percutaneous kidney access in a transplanted kidne y. The percutaneous access was successful in 98% of the attemps. A posterio r calyx of the lower group (74%), of the medium group (25%) or of the upper group (1%) was accessed. In 73 accesses the mean target calyx diameter was 12.8 mm (range 5-45 mm), the mean operative time 5.4 minutes and the mean fluoroscopy time 5.1 seconds. In 84.5% of the patients the access was perfo rmed under local anesthesia when a dilation of the tract was not required. Gross haematuria was observed in 3.9% of the accesses and an arterial lesio n treated by embolization in 0.9% of the accesses. Blood transfusion was re quired in 0.3% of the patients. The ultrasound-fluoroscopy guided access is at least as precise as the fluoroscopy guided one moreover it makes the pr ocedure less invasive and it makes more precise the surgical planning.