Prone PCNL Without Inserting Ureteral Catheter (View From Surgeon's Eyes)

Standard prone PCNL technique involves two steps: placing a ureteral catheter and then flipping the patient back to a prone position. However, many authors have reported that the step of placing a ureteral catheter can be omitted and the needle can still be guided into the kidney (focusing on the stone). In our department, we have been using this technique for nearly 5 years and have shown its feasibility and safety, without any increase in postoperative complications. 

The issue of omitting the placement of a ureteral catheter may raise some debate, and we do not intend to refute this. However, in the hands of experienced PCNL surgeons, this technique is not difficult to perform (depending on the case, but not applicable to all). The advantage is that it saves time, reduces the amount of X-rays, and avoids the need to remove the ureteral stent if an antegrade JJ stent needs to be placed. Some information to support the non-ureteral-catheter approach includes:

* Some centers with intrarenal pressure measuring devices have shown that omitting the placement of a ureteral catheter does not increase intra-renal pressure.

* Regarding the targeting of the kidney puncture: for example, a lower pole stone, the location of the stone is also the location of the lower pole calyx. Another example, for a stone adhered to the upper end of the JJ stent, placement of a ureteral catheter may not always be feasible.

* In a lecture by the European School of Urology (on uroweb.org), many experts have also shown that accurately puncturing the papilla of kidney does not guarantee less bleeding during and post PCNL surgery. Remember that in cases of hydronephrosis, even when using ultrasound guidance, we cannot always ensure that the needle goes directly into the papilla.