JCU - January 2022 - 11

Irani et al.
11
pyelography27,28 is safe and successful in PCNL, in particular
situations in which ureteral catheter insertion is
difficult or impossible, such as patients with urinary
diversion, ureteral reimplantation, angulated ureter and
bladder neck elevation,29-31 the stone-directed antegrade
method of access can help in performing PCNL as a problem-solving
and effective procedure in these patients.
In addition, in selected patients with a small stone burden,
no residual stone and minimal bleeding, this procedure
can be done without nephrostomy tube insertion
(totally tubeless PCNL), which significantly reduces the
length of hospital stay and analgesic requirements without
increasing the complications.32
Conclusion
The stone-directed antegrade approach using the 'bull's
eye' technique is a safe and accurate method of access in
PCNL, particularly in special situations such as patients
with urinary diversion and ureteral obstruction and in
those who have opaque or semi-opaque stones. The technique
not only obviates the need for retrograde catheter
insertion, but also reduces the operative time and is more
convenient form the patients' point of view. Multi-centre
studies on a larger group of patients are needed to support
the results of this study.
Conflicting interests
The authors declared no potential conflicts of interest with
respect to the research, authorship and/or publication of this
article.
Funding
The authors disclosed receipt of the following financial support
for the research, authorship and/or publication of this article: The
Vice-Chancellery of Research and Technology of Shiraz
University of Medical Sciences financially supported this study.
Ethical approval
The protocol was in accordance with the Declaration of Helsinki
and the local committee (ethical code: IR.SUMS.REC.1396.167).
Informed consent
Written informed consent was obtained from all subjects before
the study.
Guarantor
A.H.
Contributorship
D.I. contributed to the design and did the surgery, drafted the
manuscript, obtained the final approval and accepts accountability
for the overall work. M.M.H. and A.H. contributed to the
design, did the surgery, revised the manuscript, obtained the final
approval and accept accountability for the overall work. L.M.
and M.A.A. contributed to data collection and data analysis,
revised the manuscript, obtained the final approval and accept
accountability for the overall work. H.R.S. contributed to data
collection, revised the manuscript, obtained the final approval
and accepts accountability for the overall work.
Acknowledgements
The authors would like to thank Shiraz University of Medical
Sciences, Shiraz, Iran, as well as the Centre for Development of
Clinical Research of Nemazee Hospital and Dr Nasrin Shokrpour
for editorial assistance. The Vice-Chancellery of Research and
Technology of Shiraz University of Medical Sciences financially
supported this study.
Supplemental material
Supplemental material for this article is available online.
ORCID iD
Abdolreza Haghpanah
7049
https://orcid.org/0000-0002-9728References
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https://www.orcid.org/0000-0002-9728-7049 https://www.orcid.org/0000-0002-9728-7049

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