Re: Endoscopic retrograde renal access for percutaneous nephrolithotomy: A simplified step‐by‐step technique utilizing RetroPerc®

The video article by de Amorim et al.[1] introduces the RetroPerc® technique, a novel method for renal access during percutaneous nephrolithotomy (PCNL). This approach leverages retrograde access through flexible ureteroscopy and retrograde pyelography, representing a significant advancement over traditional antegrade methods. The RetroPerc® technique addresses a critical challenge in PCNL—renal access. Despite being the recommended first-line treatment for large kidney stones, PCNL's adoption has been limited due to the complexities of achieving renal access. The reliance on interventional radiology not only increases costs but may also result in suboptimal access points, potentially compromising stone removal efficacy. By enabling urologists to perform their own access using familiar retrograde techniques, RetroPerc® has the potential to streamline the procedure, reduce dependency on interventional radiology, and improve clinical outcomes. The manuscript provides a comprehensive step-by-step guide to the RetroPerc® technique, supported by a video demonstration. This includes patient positioning, the use of fluoroscopic and endoscopic guidance, and precise steps for achieving renal access. The described case of a 31-year-old female with a partial staghorn calculus highlights the technique's efficiency, with renal access achieved in just 23 s of fluoroscopic time, and the patient discharged within 24 h without complications. The RetroPerc® technique's ability to allow urologists to target the optimal calyx for stone treatment is particularly noteworthy. This precision is crucial for complex cases, such as staghorn calculi, where effective stone clearance is paramount. Additionally, by eliminating the need for interventional radiology, RetroPerc® can reduce procedural costs, shorten hospital stays, and enhance patient recovery. Fluoroscopic guidance has long been the standard for renal access in PCNL due to its precision and familiarity among urologists. Techniques such as the triangulation and bullseye methods are commonly used to achieve accurate calyceal access[2]. However, the reliance on fluoroscopy raises concerns about radiation exposure for both patients and healthcare providers[3]. Ultrasound-guided access is emerging as a viable alternative, offering several advantages, including reduced radiation exposure and the ability to visualize the kidney in real time[3, 4]. Studies have shown that ultrasound-guided PCNL can be as effective as fluoroscopic methods, with the added benefit of being safer for patients with complex anatomy[5, 6]. The adoption of ultrasound guidance is increasing, particularly in regions where reducing radiation exposure is a priority[7]. This video also emphasizes the technique's reproducibility and potential for widespread adoption, even among urologists without advanced endourology training. This could significantly increase the number of PCNL procedures performed, especially in regions with limited access to interventional radiology. The introduction of RetroPerc® represents a significant advancement in the field of endourology. By simplifying renal access for PCNL, this technique has the potential to improve patient outcomes, reduce healthcare costs, and expand the capabilities of urologists. Further studies, including the ongoing multi-institutional prospective trial, will be essential to validate the long-term efficacy and safety of this innovative approach. Rodrigo Donalisio da Silva was solely responsible for the conceptualization and drafting of this editorial comment. The author declares no conflict of interest. The author has nothing to report.