Current Trends in Percutaneous Nephrolithotomy in China: A Spot Survey

Abstract

Objective To describe trends in the procedure of percutaneous nephrolithotomy (PCNL) in China to identify training needs. Methods A spot survey with 36 questions, which revealed demographic data, patterns of PCNL practice, and opinions regarding specific clinical cases, was administered to Chinese urologists during the 17 th National Urological Urolithiasis Symposium held in Dandong in 2018. Results Out of 400 participants, 221 responses to the survey were received. PCNL was performed by 80.5% of the participants, and 70.2% of them were senior clinicians. It was found that 91% used the prone decubitus in training programs and 27.6% the modified supine, and 46.6% were apprenticeship trained for PCNL, while 5.6% trained during their residency. The prone position was the preferred decubitus, even for obese patients. All of the urologists established their own access, 93.7% used ultrasonography guidance alone, 70.7% used ultrasonic and/or pneumatic lithotripters, and 29.2% used laser. When exiting the kidney, 73.8% placed a nephrostomy tube whereas 26.2% used the tubeless technique. For postoperative follow-up, 51.3% used computed tomography (CT) or ultrasonography plus kidney–ureter–bladder (KUB) to monitor the results of procedures, while 45% used KUB alone. Colonic injury was reported by 8.9%. Average hospital stays of >3 days were reported for 81.2% of procedures. Conclusion Chinese urologists obtain their own access during PCNL, with ultrasonic guidance in most cases, and almost a half of them are apprenticeship trained. They prefer the prone position, use fascial dilators, and place a nephrostomy tube when exiting the kidney. Most urologists follow the official management guidelines in special cases. Skilled use of urological ultrasound examination, flexible nephroscopy, postoperative CT, tubeless procedures in selected patients, and urology residency training are recommended for PCNL practice.

A randomized controlled study of ureteral stent extraction string on patient’s quality of life and stent-related complications after percutaneous nephrolithotomy in the prone position

“…It has been reported to be both safe and effective, as well as associated with a shorter hospital stay and a reduced incidence of postoperative pain [ 6 , 22 , 23 ]. Nevertheless, completely tubeless PCNL technique (neither ureteral stent nor nephrostomy tube) is still challenging and must also be performed by experienced surgeons [ 7 , 24 – 26 ].…”

“…During PCNL, it is typically recommended to place a nephrostomy tube and double-J stent to ensure proper urine drainage, facilitate the discharge of residual stones, and assist with compression hemostasis [ 4 ]. Recently, with the improvement of PCNL technology and the emphasis of enhanced recovery after surgery, more and more studies have demonstrated that tubeless PCNL (with ureteral stent but without nephrostomy tube) is a safe and ideal surgical approach [ 5 – 7 ]. Nevertheless, the internal double-J stent needs to be removed with a cystoscope in the outpatient clinic, which increases the patient's cost and pain and raises the risk of bleeding, infection, and urethral injury [ 8 ].…”

The Relationship between Preoperative Urine Culture and Post-Percutaneous Nephrostolithotomy Systemic Inflammatory Response Syndrome: A Single-Center Retrospective Study

“…However, we should note that complications of PCNL include SIRS, intraoperative bleeding, postoperative bleeding, perforation and tear of renal collecting system, water electrolyte disorder, peripheral organ injury, urinary cyst formation, wound nonunion, and more [ 4 , 5 , 6 ]. The occurrence of postoperative SIRS may seriously endanger the patient’s life and health, due to septic shock.…”

“…At present, percutaneous nephrostolithotomy (PCNL) is the first-line treatment for large renal (≥2 cm), cast, or staghorn calculi [ 1 , 2 , 3 , 4 ]. However, PCNL is also associated with complications [ 5 , 6 ], such as bleeding, colonic injury, and postoperative sepsis.…”

Can we identify the risk factors for SIRS/sepsis after percutaneous nephrolithotomy? A meta‑analysis and literature review

“…Nowadays, PCNL is a ubiquitous technique. In a recent survey by Jiang et al ( 2 ), ~80.5% of urologists in China practice PCNL and 96.2% said they like to perform it. According to the European Association of Urology, PCNL is recommended as the first-line treatment for kidney stones >2 cm and/or staghorn stones ( 3 ).…”