Fluoroscopy-guided percutaneous renal access

Percutaneous renal surgery is dependent upon appropriate access to the targeted portion of the collecting system. Obtaining a well-positioned nephrostomy tract improves the urologist's ability to both obtain the desired surgical outcome and minimize attendant morbidities. The two primary methods of obtaining fluoroscopic-guided percutaneous renal access-"bull's eye" targeting and triangulation-are reviewed. The authors' preferred techniques are outlined, technical refinements are noted, and recent modifications and future directions are reviewed.