We report the results of 1,000 consecutive patients who underwent percutaneous removal of renal and ureteral stones. Removal was successful for 98.3 per cent of the targeted renal stones and 88.2 per cent of the ureteral stones. Complications, evolution and technique are discussed. Percutaneous techniques are an effective way to handle the majority of renal calculi and these techniques will continue to be important as shock wave lithotripsy becomes more widespread in the United States.

Two patients had colonic perforation as a result of percutaneous nephrostomy placement followed by track dilatation and renal calculus removal. We present the technical aspects of nephrostomy placement and stone removal, as well as the clinical diagnosis and management of these cases. Both patients recovered well with conservative therapy and required no surgical intervention. This report reviews the anatomic considerations for percutaneous nephrostomy in patients undergoing renal stone removal.

Complications of indwelling ureteral stents were managed percutaneously in 13 patients. These complications consisted of three fractured, three heavily encrusted, and seven migrated stents. While most ureteral stent malfunctions are routinely managed with retrograde techniques, the percutaneous approach allows effective clinical management in selected cases in which extensive renal stone material or brittle intrarenal stent fragments are present or when previous surgery or ureteral strictures do not permit a retrograde approach. Fluoroscopically guided removal of migrated stents and percutaneous endoscopic techniques, for complex cases such as those requiring stone removal, were successful and without complications.

Percutaneous nephrostomy placement was performed in 700 patients as the initial procedure in renal or ureteral calculus removal. The ease or complexity of the subsequent calculus removal procedure is directly dependent on precise nephrostomy placement. The most important technical factors in nephrostomy placement for calculus removal are selection of the nephrostomy track course, the track entry site into the renal collecting systems, intrarenal catheter and guidewire manipulations, and the final catheter positioning across the ureteropelvic junction and down the ureter.

Progressive chronic pyelonephritis (CPN) leading to renal failure was, in the past, a mode of death in children with meningomyelocele (MMC). With more sophisticated management modalities, renal failure is now uncommon, but the problem of CPN still remains. In this series of 100 children with MMC, 39% have CPN. It is significantly more common in girls than in boys. There is a strong relationship between CPN and vesico-ureteric reflux (VUR). There is no association with raised bladder pressure. The majority of CPN arises in children under the age of 4 years, but damaged kidneys can continue to deteriorate. Although chronic renal failure is rarely seen in children with MMC, there is a risk that this may merely be postponed into adulthood.