Percutaneous nephrolithotomy: Three-needle technique on two planes. Cury's technique.

INTRODUCTION: Percutaneous nephrolithotomy is the main type of surgery indicated for kidney stones larger than 2 cm. The present study describes a three-needle technique for percutaneous nephrolithotomy on two planes. SURGICAL TECHNIQUE: The patient is first placed in the lithotomy position for cystoscopy, which guides the ureteral and urethral catheter. Next, the patient is placed in ventral decubitus for the three-needle technique. With the aid of the nephroscope, the first needle is positioned in the projection of the renal pelvis, the second needle is placed in the most posterior of the inferior calyces and the third needle is aligned with the other two at the most depressible point determined by the surgeon's index finger. After alignment in the topography of the third needle, an incision is made with the scalpel 1-2 cm perpendicular to the aponeurosis of the latissimus dorsi muscle. The second needle is replaced with a peridural needle, which is used to confirm the location of the inferior renal calyx and limit the depth of the Chiba needle inserted in the topography of the third needle, forming a 90° angle with the peridural needle. The Chiba needle enables the passage of the guidewire and subsequent dilatation until the 30F caliber for the passage of the Amplatz dilator, initiating the conventional procedure. COMMENTS: The technique described has been used at our service for 15 years and has the advantages of less morbidity, fewer complications and less use of the nephrostomy tube. The technique is also easy to learn and highly reproducible.

Análise da dinâmica renal em modelo experimental: ligadura ureteral pélvica / An experimental canine model of pelvic uretral ligature: renal evolution analyses

O objetivo do presente trabalho foi estipular experimentalmente, através de biópsias semanais em cães, a época de aparecimento de alterações histopatológicas significativas no parênquina renal (até a obtenção de atrofia renal), após ligadura cirúrgica unilateral a nível de junção uretero-vesical (JUV). Observou-se início de comprometimento da citoarquitetura renal a partir da 2ª semana pós-obstrução ureteral baixa, culminando-se com a exclusão renal na 19ª semana. Foram analisadas, a seguir, as dificuldades inerentes à condução terapêutica da uropatia obstrutiva distal