This instructional video has been prepared by Julio Davalos,MD, of Chesapeake Urology Associates, who is also affiliated with theUniversity of Maryland. Dr. Davalos begins the video by explaining that percutaneousnephrolithotomy (PCNL) is currently underutilized, in part, because renalaccess is not taught during residency. Since completing his own residency, Dr.Davalos has developed this step-by-step process for achieving renal access.Each step is described and illustrated, including: cystoscopy and placement ofthe injection catheter, radiographic and skin template mapping of the renalsystem, placement of the access needle in the collecting system, dilation ofthe tract and placement of the safety wire, increasing the size of the tractwith a balloon dilator, and placement of an access sheath. Dr. Davalos alsoreviews key steps in the PCNL procedure itself and offers various tips andtricks to help improve surgical outcomes.