Percutaneous Access of Nondilated Renal Collecting Systems

Interventional radiology (IR) has seen an increase in the numbers of patients referred for urinary diversion in patients with ureteral leaks. This increase has corresponded to the increasing use of complicated surgical procedures for lower urinary tract tumors. These procedures are often relatively difficult to perform for two reasons: first, the renal collecting systems are typically completely decompressed due to the leak; second, many of these patients have recently undergone a significant operation via a ventral approach, making patient positioning difficult. The latter issue is relatively easy to control with the aid of anesthesiologists and the creative use of bolsters and pillows, although in the worst case scenario patients may have to be positioned in a lateral decubitus position (further complicating an already difficult procedure). The discussion below outlines the authors' procedural algorithm in gaining percutaneous collecting system access in this difficult patient population.

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