Imaging for Percutaneous Renal Access and Management of Renal Calculi

PCNL is an image-driven treatment modality that relies heavily on:•Preoperative imaging to define stone burden and delineate the relational anatomy of the kidney•Intraoperative imaging to facilitate percutaneous puncture, endoscopic inspection, and pleural screening•Post-operative imaging to detect residual stones and assure antegrade drainage. The emergence of CT as the imaging modality of choice for detecting renal calculi and the ability of CT urography with or without three-dimensiona reconstruction to delineate the collecting system make this the most versatile and sensitive imaging modality for use in PCNL. Fluoroscopy remains the mainstay of intraoperative imaging, but CT fluoroscopy holds promise in enhancing the ability to obtain safe percutaneous access and to detect residual stones. At present, IVU and ultrasound continue to play a role in the percutaneous management of patients who have renal calculi.