Dr. Krambeck discusses a percutaneous nephrolithotomy procedure in a 54-year-old woman with a large upper pole stone completely obstructing the upper pole system. The patient was referred to her after undergoing a previous percutaneous stone removal in which, despite multiple percutaneous accesses into the kidney, the referring urologist was unable to advance a wire into the standard collecting system and down the ureter. Dr. Krambeck discusses the importance and benefits of utilizing the Perc-Tic technique, a percutaneous diverticulum access technique for this type of situation. She provides information on the devices and a step-by-step process to the technique required to circumvent the obstruction, remove the stone, and find/reopen the connection to the collecting system.
Amy E. Krambeck, MD, Northwestern Medicine
Michael O. Koch, Professor of Urology, Indiana University, USA
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