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Eisner BH et al. – For percutaneous lower–pole renal access, the most medial calix on coronal CT imaging and therefore retrograde opacification using fluoroscopy is almost always anterior facing and is the most anterior positioned in the majority of kidneys. Percutaneous lower–pole puncture should be directed at the more lateral calices because their posterior position and orientation provides optimal access to the collecting system for most cases. This anatomic understanding is critical for successful percutaneous nephrolithotomy.

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