nephroscopy

Nephroscopy is an endoscopic technique for visualizing the kidney's collecting system, typically performed with a nephroscope inserted percutaneously into the renal pelvis and calyces. It allows direct inspection of the intrarenal collecting system and, when combined with intervention tools, enables diagnostic assessment and treatment.

Equipment and technique: Nephroscopes can be rigid or flexible. Access is obtained percutaneously under imaging guidance (ultrasound or fluoroscopy). A tract is dilated to allow a percutaneous sheath; the collecting system is irrigated to maintain visibility. Interventions include stone fragmentation and extraction using laser, ultrasonic or pneumatic lithotripsy, graspers, and retrieval baskets. The procedure is commonly used in percutaneous nephrolithotomy (PCNL).

Indications: management of complex kidney stones, including large or staghorn calculi; evaluation of intrarenal pathology, collecting system tumors or strictures; intrarenal biopsy or assessment of anomalous anatomy; persistent hematuria when noninvasive imaging is inconclusive.

Alternative and relation to other procedures: compared with ureterorenoscopy, nephroscopy provides direct access to the entire renal collecting system via a percutaneous tract, useful for larger stones; however, it requires tract creation and carries specific risks.

Risks and outcomes: potential complications include bleeding, infection, urinary leakage, injury to renal parenchyma, injury to surrounding structures. Recovery may involve nephrostomy tube or ureteral stent placement; many patients experience rapid stone clearance with PCNL. Nephroscopy can also be performed diagnostically with minimal intervention when no stone is present.