Hi has anyone heard of / tried retrograde access for PCNL?
Retrograde access?
- Thread starter UroBeat
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I've heard of it, but never tried it. To me it seems like a bit of a solution in search of a problem, as I've never had any significant difficulties getting antegrade access. The cases where antegrade access is difficult (full stag, no room to get wire down) are also impossible retrograde because there's no way to get the scope to the papillae.
The theoretical benefit of puncturing right on the center of the papillae and thus reducing bleeding is just that, theoretical. I find this is outweighed by the possibility of losing orientation and making your tract more anterior or lateral then anticipated versus using external landmarks which are fixed. I'd like to see it, as it's always good to have another tool/trick in your toolbox, but don't see it being my go to.
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OK, I'm not a stone guy; contrarily I hate stone procedures. I particularly hate how I feel limited using a flexible renoscope during the RIRS or using a regular nephroscope doing a PCNL. However, I suppose if you can do retrograde access, thus you should have a good intrarenal space, and probably you can also carry out an RIRS 🙂 So, practically I do not think it will have such a big place in the OR. However, I think we are going to see a lot of papers out there report outcomes, etc. until some time. Then we will forget it 😀
