Similarly, the posterior calyces of the kidneys are at a 30Adeg oblique angle to the vertical plane when the patient is prone.10 The posterior
calyceal approach of lower pole in prone position with a limitation due to the maintaince of the angle is considered as the safest approach13, with minimal injury to the renal parenchyma as well as infundibular or other vessel injuries, which may have catastrophic consequences..
After prone positioning with adequate padding, posterior
calyceal puncture was done under fluoroscopic guidance.
Access to inferior
calyceal system was performed and dilated until an 30 F Amplatz sheath was placed.
According to several studies, the possible risk factors of subcapsular or perirenal hematoma post-ESWL include hypertension, coagulopathy, thrombocytopenia, drugs influencing blood coagulation, diabetes mellitus, coronary artery disease, generalized atherosclerosis, obesity, increasing age, stone location (
calyceal calculi), a larger stone size, increasing numbers of shocks, a higher shock wave voltage, and a greater frequency.[1],[3],[4],[5],[6],[7] Reported incidences of post-ESWL subcapsular or perirenal hematoma range from <1% to >30%.
In our opinion, a narrow infundibulum was the key parameter that affected movement of rigid equipment to reach other
calyceal stones.
In such cases, a rupture at the level of
calyceal fornix provides decompression and protects the kidney from a high-pressure injury.
After positioning the target
calyceal calculus, the needle tip label and the puncture trajectory of puncture needle in the tissue can be seen on the screen of the ultrasonic display during puncture, and the perspective, depth and location of the tip can be always observed.
Then in prone position
calyceal puncture was done with spinal needle 18G, 0.35 inch guide wire was placed through spinal needle and serial metallic dilatation up to 30F was done.
Calyceal stones have poor outcome with ESWL treatment compared to renal pelvic and ureteral stones, whereas lower pole renal calculi have poorer results with ESWL compared to middle and upper pole calculi.
Anatomical variations of the
calyceal system, ureter, main vasculature and parenchyma are typically the rule when dealing with congenitally fused kidneys.
A collecting system was identified as non-dilated if no
calyceal dilatation was observed on US.
Radical surgery had to be done in one patient after 4.5 years because of infiltrating tumor recurrence, and transurethral endoscopic resection was done successfully in three patients with
calyceal recurrence.