TIPS & TRICKS - Mini-PCNL with Large Intrarenal Cyst

Mini-PCNL in a kidney with a large intrarenal cyst compressing the collecting system

A large intrarenal cyst that is compressing the collecting system. A rather large stone can be seen in the lower pole. It has been decided to perform a mini-PCNL. Note the compression of the collecting system during retrograde pyelography. First, in order to expand the lower pole calyx and avoid entering into the renal cyst during PCNL access, needle aspiration of the cyst is preformed. Then, after aspiration, further retrograde pyelography is performed showing a well-expanded collecting system. Access through the lower pole and placement of a wire that coils in the collecting system.

The dilatation of the tract is performed up to 17 Fr. Due to the small tract, it is possible to also check also the upper pole. In this case, most of the stones are cleared due to the vacuum effect.