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.,,,,, 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
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.
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