Patient 1 was a 69 year-old male with history of bladder cancer with radical cystectomy and neobladder creation. He presented with slight pelviectasis and rising creatinine, as well as urinary tract infection. Multiple initial attempts using a 22 gauge Chiba needle failed because Abstract Purpose: To describe a new coaxial needle technique for percutaneous nephrostomy. Materials and methods: The technique was performed in six patients where standard ultrasound guidance techniques had failed. A

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... 5 cm, 18 gauge trocar needle was placed adjacent to the renal capsule under ultrasound guidance and a 20 cm, 22 gauge Chiba needle was then placed through the 18-gauge needle to access the renal collecting system. Results: Successful access into the renal collecting system was achieved in all patients with no complications. Conclusions: The coaxial needle technique can be used to successfully access the renal collecting system in a manner that is safe and effective.