Instrumentation and Surgical Technique: Postoperative Imaging Following Percutaneous Nephrolithotomy

The goal of imaging after percutaneous nephrolithotomy is to assure complete stone removal and anterograde urinary drainage and to identify potential complications. Computed tomography offers the most sensitive and specific modality for detecting residual stone fragments and readily detects perinephric hematomas or injuries to surrounding organs. The role of antegrade nephrostogram is controversial but it provides some assurance of the absence of distal obstruction prior to nephrostomy tube removal. Routine immediate postoperative chest radiography is not necessary for the diagnosis of clinically significant hydropneumothorax but clinical suspicion should guide the need for postoperative chest imaging. Intermediate and long-term imaging is aimed at detecting stone recurrences and the frequency and type of imaging are dictated by the metabolic activity of the individual patient.