i-PCNL: a novel ureteral-catheter application for continuous unidirectional high-flow irrigation during Percutaneous Nephrolithotomy. Technique description and preliminary outcomes.

INTRODUCTION

Percutaneous nephrolithotomy (PCNL) remains the technique of choice for the treatment of complex renal stones. Despite technical advances, limitations remain in terms of visibility, fragment migration, and effective evacuation of the material. Optimizing irrigation is the key to improve the efficiency and safety of the procedure.

MATERIALS AND

METHODS

A prospective observational study was done at one referral center, including 14 patients undergoing supine PCNL. A continuous retrograde irrigation technique directed at the upper renal pole was evaluated by adapting commercially available ureteral devices of a specific caliber. Irrigation was performed using a passive system based on hydrostatic pressure dependent on the height of the irrigation bags. Demographic variables, stone characteristics, operative and postoperative parameters, complications, stone-free rate (SFR), and a subjective evaluation of the system using a Likert scale were analyzed.

RESULTS

The technique was performed in all cases without incident. No migration of fragments to the upper pole was observed. The mean effective lithotripsy time was 10.07 min. No relevant complications were recorded, except for one case of postoperative anemia. The SFR was 100% in the tomographic control at 4 weeks. The subjective assessment showed high scores for irrigation efficacy, vision quality, and fragment evacuation.

CONCLUSIONS

Continuous retrograde irrigation during PCNL is a simple and reproducible technique that, in this preliminary series, showed favorable results, making it a promising option.