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A 16F nephroscope with a 5F cutting element was used for percutaneous removal of kidney stones in 10 patients in whom an open operation otherwise would have been necessary. Stone removal was accomplished via percutaneous incision of narrowed infundibula, caliceal diverticula and the ureteropelvic junction. A thorough knowledge of renal vasculature, meticulous care and fluoroscopic control are necessary for successful percutaneous intrarenal electrosurgery.

Significant immediate and delayed vascular complications occurred in 4 of 140 patients (3 per cent) undergoing percutaneous removal of renal and ureteral calculi. An understanding of renovascular anatomy, use of a safety guide wire and intraoperative availability of an angiographic balloon catheter may help to prevent and to treat bleeding problems.

A percutaneous nephrostomy tract was used as a conduit to the kidney and ureter for extraction of 149 calculi in 100 patients. A variety of grasping and fragmentation techniques under fluoroscopic and endoscopic control were used to extract calculi in 88 per cent of the patients. With experience, operator efficiency and rate of stone extraction increased from 76 per cent early in the series to 91 per cent in the most recent patients, and the incidence of complications decreased from 17 to 5 per cent. Percutaneous removal of upper tract urinary calculi appears to be an appropriate alternative to an open operation in most patients with symptomatic urolithiasis.

Mazzariello-Caprini forceps were used percutaneously to remove a stone that was impacted distal to the ureteropelvic junction in a patient who had undergone several previous open pyelolithotomies. These forceps open by a rotational rather than a scissoring movement so the shaft size does not increase and they are well suited for operation through a narrow nephrostomy tract. The original design has been modified to allow passage over an angiographic guide wire, thereby placing the forceps precisely at the site of the stone. Also, with the angiographic guide wire to direct them the forceps can be used in a freshly established nephrostomy tract as well as in a mature tract. In our experience the Mazzariello-Caprini forceps have been most useful for nonoperative manipulation of renal and upper ureteral calculi.