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Clinical History:
A 65-year-old female with left abdominal pain
Non-contrasts abdominal CT scan demonstrated a 25-30mm UPJ stone
Technique description:
Ultra-Mini-PCNL using the MOSES 2.0 holmium laser technology
Procedure steps:
Patient in prone position, insertion a 5f ureteral catheter using flexible cystoscope to the left kidney
Insertion of a Foley catheter
Changing gloves. Injection of contrast media through the ureteral catheter to get the collecting system road map
By using fluoroscopy, and the bullseye technique, selection of the most appropriate calyx for puncture
Use of an 18G needle for the puncture. Insertion of a curved hydrophilic wire, and direct it to the urinary bladder using a 5F hockey stitch catheter.
Switch the wire to extra stiff amp lays for dilatation
2-3 steps tract dilatation using 8/10, and then 12 and 14F dilators, followed by 14F sheath.
Switch the extra stiff wire to strait, hydrophilic wire
Inserction of the 12F miniature nephroscope, find the stone, and break it with Holmium laser, MOSES 2.0 technology. Laser setup-0.2-0.3J on 120 Htz.
Take all fragments out using vacuum cleaner effect, 3F basket, or back wash of saline from the ureteral catheter
Screen the entire collecting system for residual fragments using fluoroscopy and direct vision. We use Flexible ureteroscope when needed.
Antegrade insertion of 6F ureteral stent
One stitch of 3-4/0 rapid vicryl on the skin, and then dressing on the wound
Training Objectives:
