ECIRS with “Matryoshka” Technique for a Complete Staghorn Stone

The patient was placed in the Galdakao-modified supine Valdivia position. A puncture was made under ultrasound and X-ray control in a posterior lower calyx, seeking a transpapillary puncture. The calyx entry was blocked, and the guidewire could not pass into the renal pelvis. An initial dilation of up to 16Ch was required to make room in this calyx access so to then place the guidewire in the ureter (“through and through” situation). A standard access (24Ch) was created using Amplatz serial dilators. A rigid nephroscope and lithotripsy using combined ultrasonic and ballistic energy with suction was used to remove the stone burden in the calyx access and renal pelvis. Flexible nephroscopy and laser were required to treat some fragments in the upper calyx and proximal ureter. Stones in the middle calyx were cleared out using a flexible ureteroscope inserted retrogradely (ECIRS) and extracted through the Amplatz sheath. A final endoscopic review did not reveal any residual fragments. At the end of the procedure a double J stent was placed without a nephrostomy tube, after having performed an endoscopic control of the percutaneous tract.

Clinical Case:

Clinical Background

• Age: 50

• Gender: female

• Weight: 65 kg

• Height: 1.68 m

• BMI: 23 kg/m2

• Diagnosis: Complete staghorn stone in the left kidney

Technique Description