Cómo citar este artículo: Sánchez-Bermeo A, et al. Experiencia inicial nefrolitotomía percutánea, posición de Valdivia modificada para el tratamiento quirúrgico en pacientes con litiasis renal. Rev Mex Urol. 2015. http://dx.

202 www.revistamexicanadeurologia.org.mx caso clínico Rev Mex Urol. 2018 mayo-junio;78(3):202-206. Nefrolitotomía percutánea: implementación de la inserción y disección digital como coadyuvante de la técnica Percutaneous nephrolithotomy: implementation of digital insertion and dissection as an adjunct to the technique AFR. Percutaneous nephrolithotomy: implementation of puncture and digital dilation as an adjunct to the technique. Rev Mex Urol. 2018 mayo-junio;78(3): 202-206. DOI:https://doi.org/10.24245/revmexurol.v78i3.1834Resumen ANTECEDENTES: La nefrolitotomía percutánea (PCNL) se estableció como una opción de tratamiento mínimamente invasiva para los cálculos renales desde la década de 1970, es segura y eficaz (tasas de aclaramiento lítico del 78 hasta 95%). La punción ideal debe maximizar la efectividad del procedimiento en términos de tasa libre de cálclulos renales y minimizar el riesgo de complicaciones.CASO CLÍNICO: Paciente masculino de 36 años de edad con dolor lumbar bilateral. En la urotomografía se apreció litiasis bilateral, la derecha compatible con un lito coraliforme incompleto y un colon retrorrenal derecho. Primero se practicó nefrolitotricia flexible izquierda y posteriormente nefrolitotomía percutánea derecha. Se efectuó una punción bajo guía fluoroscópica apoyada mediante una disección digital de todas las capas de la pared abdominal hasta acceder al retroperitoneo para evitar una lesión colónica y formar un túneal a través del que se logró palpar la unidad renal.CONCLUSIONES: La técnica de punción y dilatación digitalizada ofrece un acceso seguro y efectivo en pacientes con factores de riesgo de complicaciones por cálculos renales.Abstract BACKGROUND: Percutaneous nephrolithotomy (PCNL) was established as a minimally invasive treatment option for kidney stones in the 1970s and is considered a safe and effective procedure, with stone clearance rates of 78-95%. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free status and minimize the risk of complications. CLINICAL CASE:We present the case of a 36-year-old male patient with bilateral lower back pain. A CT urography scan was performed that revealed bilateral lithiasis. The stone on the right side was consistent with an incomplete staghorn stone and a right retrorenal colon was identified. Left flexible nephrolithotripsy and subsequent right percutaneous nephrolithotomy were performed. A puncture was made under fluoroscopic guidance supported by previous digital dissection of all layers of the abdominal wall until gaining access to the retroperitoneum. Colonic lesion was prevented and a tunnel through which the renal unit could be palpated was formed. CONCLUSIONS:The technique of digital insertion and dissection offers safe access to the renal unit that is useful in patients presenting with risk factors for a potential complication.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) was established as a minimally invasive treatment option for kidney stones in the 1970s and is considered a safe and effective procedure, with stone clearance rates of 78-95%. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free status and minimize the risk of complications. CLINICAL CASE: We present the case of a 36-year-old male patient with bilateral lower back pain. A CT urography scan was performed that revealed bilateral lithiasis. The stone on the right side was consistent with an incomplete staghorn stone and a right retrorenal colon was identified. Left flexible nephrolithotripsy and subsequent right percutaneous nephrolithotomy were performed. A puncture was made under fluoroscopic guidance supported by previous digital dissection of all layers of the abdominal wall until gaining access to the retroperitoneum. Colonic lesion was prevented and a tunnel through which the renal unit could be palpated was formed. CONCLUSIONS: The technique of digital insertion and dissection offers safe access to the renal unit that is useful in patients presenting with risk factors for a potential complication. KEYWORDS: Digital; Kidney; Lithiasis; Percutaneous nephrolithotomy.

BACKGROUND: Percutaneous nephrolithotomy (PCNL) was established as a minimally invasive treatment option for kidney stones in the 1970s and is considered a safe and effective procedure, with stone clearance rates of 78-95%. The ideal puncture should maximize the effectiveness of the procedure in terms of stone-free status and minimize the risk of complications. CLINICAL CASE: We present the case of a 36-year-old male patient with bilateral lower back pain. A CT urography scan was performed that revealed bilateral lithiasis. The stone on the right side was consistent with an incomplete staghorn stone and a right retrorenal colon was identified. Left flexible nephrolithotripsy and subsequent right percutaneous nephrolithotomy were performed. A puncture was made under fluoroscopic guidance supported by previous digital dissection of all layers of the abdominal wall until gaining access to the retroperitoneum. Colonic lesion was prevented and a tunnel through which the renal unit could be palpated was formed. CONCLUSIONS: The technique of digital insertion and dissection offers safe access to the renal unit that is useful in patients presenting with risk factors for a potential complication. KEYWORDS: Digital; Kidney; Lithiasis; Percutaneous nephrolithotomy.