Background: Percutaneous nephrolithotomy (PCNL) serves as the gold standard minimally invasive procedure to remove large renal stones. The puncture is made from the skin to the chosen calix under fluoroscopic guidance, although this remains a challenging technique. We describe the initial case of retrograde holmium laser acquired nephrostomy access. Case Presentation: In this study, we present the case of a 48-year-old woman with right renal colic with imaging revealing a 2.6 cm staghorn stone. With institutional approval, we performed a new technique utilizing retrograde access with a flexible ureteroscope and a holmium laser fiber to achieve nephrostomy access for PCNL in the prone position. With the ureteroscope confirmed in the desired calix, the ureteroscope and laser fiber were aimed and fired toward the flank and thus creating a subcostal nephrostomy tract. PCNL was then carried out per standard of care lithotripsy techniques utilizing the holmium laser. Conclusion: In this initial case, percutaneous retrograde laser access allowed for desired caliceal nephrostomy access under direct vision.

Journal of endourology case reports. 2019 Aug 30*** epublish ***

Carlos A Uribe, Hugo Osorio, Johana Benavides, Carlos H Martinez, Zachary A Valley, Kamaljot S Kaler

Division of Urology, Hospital Pablo Tobón Uribe, Medellín, Colombia., Department of Urology, Clínica CES, Medellín, Colombia., Department of Urology, CES University, Medellín, Colombia., Division of Urology, Pablo Tobón Uribe, Medellín, Colombia., Department of Urology, University of California, Irvine, California., Endourology and Robotic Surgery, Department of Surgery, Southern Alberta Institute of Urology, University of Calgary, Alberta, Canada.