Re: Reduced Radiation Exposure with the Use of an Air Retrograde Pyelogram During Fluoroscopic Access for Percutaneous Nephrolithotomy (From: Lipkin ME,Mancini JG,Zilberman DE,et al. J Endourol 2011;25:563–567)

Dear Editor:

W e read with interest this article concerning reduced radiation exposure with the use air pyelography during percutaneous nephrolithotomy. Air pyelography is not a new concept and has been described previously. ¹ The advantages are numerous and also include cost-saving that is important in poor countries. In spite of these advantages, it has not become a routine method for visualizing the pelvicaliceal system during percutaneous nephrolithotomy.

It would be enlightening for the readers if the authors could elaborate on the reasons why they chose to do air or contrast pyelography on a particular patient because all the procedures were performed by only one radiologist and surgeon. In other words, in the opinion of the authors, what are the indications for or advantages of performing contrasted pyelography?

Personally, we think that contrasted pyelography is useful if the anatomy of the pelvicalyceal system is not well known before the procedure (eg, in patients with poorly functioning kidneys where intravenous pyelography is noninformative).