Evaluation of non-papillary access on the 3D-printed renal collecting system model in fluoroscopic supine percutaneous nephrolithotomy: a pilot study
Abstract Objective Fluoroscopic access techniques may not reliably differentiate between papillary and non-papillary renal access during percutaneous nephrolithotomy (PNL), potentially leading to misinterpretations that could increase complication risks. This pilot study aimed to evaluate whether a...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-07-01
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| Series: | BMC Urology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12894-025-01856-x |
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| Summary: | Abstract Objective Fluoroscopic access techniques may not reliably differentiate between papillary and non-papillary renal access during percutaneous nephrolithotomy (PNL), potentially leading to misinterpretations that could increase complication risks. This pilot study aimed to evaluate whether a novel radiopaque 3D-printed collecting system model could be used to investigate the feasibility of identifying non-papillary accesses using different biplanar fluoroscopic techniques in the supine PNL setting. Materials and methods This experimental study was conducted in February 2023 using a 3D-printed Dentagum resin model of the renal collecting system fixed in a supine position. Five intentionally non-papillary accesses (two lower calyces, three middle calyces) that appeared papillary at a 0° fluoroscopic angle were created. Four biplanar fluoroscopic access techniques (0–30° cephalad, 0–30° caudal, 0–20° lateral, and 0–90°) were then employed to detect whether these accesses could be identified as non-papillary. Results Among the five non-papillary accesses, 0–30° cephalad detected one (20%), 0–30° caudal detected two (40%), and 0–90° detected two (40%), while 0–20° lateral detected none. Both non-papillary accesses in the lower calyx were correctly identified using 0–90°, with one additionally detected by 0–30° cephalad and the other by 0–30° caudal. Of the three non-papillary middle calyx accesses, only one was detected (via 0–30° caudal), whereas the other two were missed by all tested angles. Additional angles (e.g., 60° lateral–30° cephalad) further increased non-papillary detection rates. Conclusions This pilot study demonstrates that non-papillary accesses may appear papillary under standard biplanar fluoroscopic techniques, suggesting a risk of misinterpretation and underscoring the potential benefit of incorporating additional imaging angles to improve detection accuracy. |
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| ISSN: | 1471-2490 |