What are the benefits of performing PCN through Brodels line? The approach through Brodel’s line also results in a percutaneous nephrostomy catheter exiting through skin near the posterior axillary line. So the catheter does not kink and the patient is not uncomfortable lying on it when supine. Percutaneous nephrolithotomy (PCN) is a minimally invasive procedure …
Should access for PCN be obtained through the renal parenchyma or directly into the renal pelvis? Puncture of the collecting system should occur through the renal parenchyma because this is the least vascular plane. Direct access to the renal pelvis has a higher rate of vascular complications. Puncture through the renal parenchyma also helps to …
From what approach should PCN be performed? A PCN tract should pass through the least vascular region of the kidney to minimize bleeding complications. Renal calyces are arranged in anterior and posterior rows. Between these two rows, in the interpolar kidney, is a relatively avascular plane of renal parenchyma called Brödel’s line. This plane usually …
What are the alternative means other than fluoroscopy for visualizing the collection system for PCN? Ultrasonography (US) can be used, which eliminates the need for contrast material opacification of the collecting system. US can also be used to ensure that adjacent organs do not lie along a proposed nephrostomy tract. If the collecting system is …
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What is the most common method of visualizing the collecting system for PCN? Fluoroscopy is the most common method, but this requires opacification of the collecting system. This can be accomplished by intravenous contrast material injection with antegrade excretion, if the patient has satisfactory renal function. If the patient has impaired renal function or has …
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What is the indication for emergent PCN? Pyonephrosis (infected urinary obstruction) may rapidly lead to urosepsis and death. It is a urologic emergency, and emergent drainage is indicated.
What are the important technical factors to consider when performing PCN? PCN is a relatively safe, minimally invasive technique that can be used to treat various conditions efficiently. The safety and efficacy of the procedure are predicated, however, on the following well-established guidelines to help prevent complications. The skin puncture should be sufficiently lateral to …
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