Objective: To described a needle renal lifting technique using an 18-gauge needle to adjunct ureterorenoscopy (URS) in the management of complicated proximal ureteral stones. Case(s) Presentation: A 46 years old man presented with right flank pain for 1 month. This patient was diagnosed with ureteral stone and ureteral kinking that prohibits access to the proximal side of the ureter. Due to difficult access to the proximal ureter, we perform a needle renal lifting technique which is initialized by puncturing the middle renal calyx with 18-gauge needle. Then, the proximal end of the needle was pushed to the caudal direction to move the kidney to the cephalic direction and straighten the kinked ureter. After that procedure, the URS sheat can easily enter the proximal ureter to the stone site. Discussion: The success rate of this procedure is based on the operator skills to access the calyx and perform URS simultaneously. Like a previous technique, needle renal lifting is effective only when the kidney is mobile. Conclusion: The needle renal lifting technique can be used to adjunct URS in the management of complicated ureteral stones which prohibited access to the proximal ureter.
needle renal lifting, ureteronoscopy, complicated ureteral stone
Mc Dougall EM, Liatsikos EN, Dinlenc CZ, Smith AD. Percutaneous approach to the urinary tract. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ, eds. Campbell’s Urology. 11th ed. Philadelphia: Saunders; 2016. p. 98.
Smith AD. Difficulties of ureteral access. In Smith’s Textbook of Endourology. Blackwell: Blackwell Ltd; 2012. p. 47.
Prakash J. Retroperitoneoscopic versus open mini-incision ureterolithotomy for upper- and mid-ureteric stones: Urolithiasis Vol.42. Springer; 2014. p. 133.
Marberger M. Fitzpatrick JM. Jenkins AD. Upper Urinary Stone. In stone surgery. Edinburgh: Churchill Livingstone; 1991.
M. Lezrek et al. Tricks of the Trade Needle Renal Displacement Technique for the Percutaneous Approach to the Superior Calix. 2011; 25(11): 1723–1726.