PMC5035830_01
CT cross section slides of a 75-year-old female patient, showing large UPJ stone, thinning of left renal cortex, and renal pelvis dilation.
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A 75-year-old woman underwent PCNL for partial staghorn stone in the left kidney, causing moderate hydronephrosis (Fig. 1).
CT cross section slides showing large UPJ stone, thinning of left renal cortex, and renal pelvis dilation. Red arrow shows part of colon located beside left kidney (retro renal colon).
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Access to the collecting system was achieved by single puncture of posterior lower calix under C-arm X-ray guidance, the site of puncture was 1 cm below 12th rib and 3 cm medial to posterior axillary line to avoid colonic injury (CT scan shows partly retrorenal colon) (Fig. 2).
The figure shows contrast material left renal vein and both its tributaries. (A) Site of penetration of renal vein tributery during PCNL, (B) left main renal vein, (C) ureteral stent inside left ureter.
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Through the nephroscope, contrast material was injected to the abnormal tract, and the left renal vein with two tributaries and inferior vena cava were seen (Fig. 3), consequently direct injury and penetration to the left renal vein was confirmed.