Reply by the authors

摘要

The theoretical advantage of single-tract percutaneous nephrolithotomy (PCNL) is minimizing the potential for blood loss, renal damage, and other complications, such as urine leakage and arteriovenous fistula formation by establishing 1 optimal percutaneous tract and clearing all the stones as efficiently as possible using rigid litho-tripters. For stone fragments that are neither easily nor safely accessible through the percutaneous tract using the rigid instruments, a flexible nephroscope or ureteroscope (through the percutaneous tract or in a retrograde fashion) can be used to mobilize those stones to a location that is suitable for the more efficient rigid ultrasonic/ pneumatic lithotripters. Accessing the kidney from the lower tract using flexible ureteroscopy is still a part of the procedure, because no additional tracts are created and it can be done at the same time. At present, retrograde access is used to manipulate the stones that are not reachable through the percutaneous tract and place them in a more accessible position for the percutaneous instruments.