A New Twist on an Old Technique: Lawson Retrograde Endoscopic-Guided Nephrostomy Access for Percutaneous Nephrolithotomy in Prone Split-Leg Position.

Background: A minority of urologists performing percutaneous nephrolithotomy (PCNL) achieve their own nephrostomy access. In an effort to simplify the access part of PCNL, we herein describe our initial experience with endoscopic-guided retrograde percutaneous access in the prone split-leg position. Case Presentation(s): After informed consent, a confirmed negative urine culture, and 1 week pretreatment with tamsulosin, four carefully selected PCNL patients underwent endoscopic-guided retrograde access in a prone split-leg position using the Lawson catheter. In all the four patients, we achieved endoscopic-guided retrograde upper pole access in the prone split-leg position. A single Clavien 3B complication occurred. Total fluoroscopy time for the PCNL averaged 162 seconds (51-283). Complete stone-free rate at 1 week based on CT scan was 25%, and a stone-free rate defined as <4 mm was 100%. Conclusion: Endoscopic-guided retrograde percutaneous upper pole access can be established efficiently with a modified Lawson technique in the prone split-leg position.