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Introduction:
During ureteroscopy and percutaneous nephrolithotomy orientation within the kidney is guided by two sources of information. The operator builds a mental map of the collecting system and a retrograde pyelogram can provide a visual snapshot. However, the contrast washes out and the visual reference is removed. In a kidney with complex architecture it can be challenging to navigate.
Materials & Methods:
Fluroscopic roadmapping is an imaging process mode commonly used in vascular interventional cases. When used in the kidney a mask is created that acts as a transparent and stable nephrogram. Scopes and wires can be navigated with precision in the absence of visual guidance. We describe this new application and provide initial data regarding use.
Results:
Fluoroscopic roadmapping has been beneficially applied to ureteroscopy and percutaneous nephrolitotomy. With the collecting system continuously highlighted, complex anatomy can be navigated with confidence and balloon dilators placed with greater precision.Initial qualitative results are encouraging with quantitative results presently being collected.
Conclusions:
This novel application of fluoroscopy can be applied whenever a pyelogram would be helpful. With additional experience and optimization of the technical aspects this can provide another tool for complex endourologic procedures.