Figure 1.

A patient presented with a staghorn calculus, a large stone that takes up more than one branch of the collecting system in the renal pelvis (Figure 1). The upper pole calyx was completely filled with stone.

Initial access in the lower pole of the kidney was achieved, but the surgeon wanted upper pole access as well. Using the Seldinger technique, we placed a wire into the upper calyx. The fit of the wire was extraordinarily tight, as the upper calyx was almost entirely filled with stone (Figure 2). Any catheter that we pushed into that zone would meet very high friction and resistance, so we opted for a nephrostomy drainage catheter with robust column strength and buckling resistance.

We chose to use the Expel™ Nephrostomy Drainage Catheter with Twist-Loc™ Hub based on its deliverability profile. The tip taper of the Expel™ Catheter and its metal cannula, which is flexible enough but stable, allowed us to place a nephrostomy tube in the difficult stone-filled area in the renal pelvis (Figure 3). The hydrophilic coating on the distal third of the catheter also helped with insertion and deliverability. Compared with other drainage catheters on the market, the Expel family has consistently performed very well at our institution.

Figure 2.

Figure 3.

R. Dana Tomalty, MD
Interventional Radiologist
Huntsville Hospital
Huntsville, Alabama
Disclosures: Received no compensation for this article and is not a consultant to Boston Scientific Corporation; member of the Boston Scientific Interventional Oncology Advisory Board; consultant for MicroVention.

Results from case studies are not necessarily predictive of results in other cases. Results in other cases may vary.