™ Occlusion of the renal pelvicalyceal system (PCS) creates artificial hydronephrosis congestion to facilitate puncture and prevents dislocation of stone fragments into the ureter during the procedure.
™ The patient is placed in the lithotomy position. A ureteral balloon tipped catheter (5-7 Fr) is placed retrogradely by cystourethro-scopy. Retrograde pyelography is performed to confirm correct placement of balloon catheter and location of stone. Fill the balloon with sterile water and apply slight traction (under X-ray guidance) in order to ensure that it fits snugly in the pelviureteric junction (PUJ).
™ If any problem is encountered in placing this balloon catheter a standard 7-Fr ureteral catheter without balloon can be used and is placed in the renal pelvis (placement is easier but there is a higher risk of stone dislodg-ment). Distension of the PCS in this case is created with irrigation fluid alone.
™ A Foley catheter is inserted and the ureteral catheter is attached (taped or ligated) to it. The catheter is connected to a urine bag and the ureteral catheter is attached to irrigation fluid (height: approximately 1 m above the patient). Irrigation is started.
™ Filling is performed to create hydronephrosis to facilitate puncture (tip: if failure to distend PCS fill with fluid from a syringe).
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