Percutaneous nephrolithotomy – the puncture

Abstract

ObjectiveTo determine what importance is given to the puncture and assistive technologies in percutaneous nephrolithotomy (PNL) in the current urological literature. MethodsPubMed was searched for English publications and reviews for the keywords: 'percutaneous nephrolithotomy', 'percutaneous nephrostomy', 'puncture'. The search was limited to the last 5 years, January 2016 until February 2021. Based on 183 abstracts, 121 publications were selected, read, and reviewed. References, older or seminal papers were read and cited if they contributed to a better understanding. A total of 198 references form the basis of this narrative review. ResultsThe puncture is frequently referred to as the most crucial part of PNL. In contrast, the influence of the puncture on the failure rate of PNL and the specific puncture-related complications seems to be low in the single-digit percentage range. However, there are no universally accepted definitions and standards measuring the quality of puncture. Consequently, the impact of the puncture on general PNL complications, on stone scores predicting success rates and on learning curves evaluating surgeons' performance have not been systematically studied. Assistive technologies rely on fluoroscopy and ultrasonography, the latter of which is becoming the preferred imaging modality for monitoring the entire procedure. Needle bending, a problem relevant to all puncture techniques, is not addressed in the urological literature. ConclusionsThe importance attached to puncture in PNL in the current urological literature is subjectively high but objectively low. Some basics of puncture are not well understood in urology. Disciplines other than urology are more actively involved in the development of puncture techniques.

Three-dimensional printing the navigation template for precise percutaneous renal puncture to treat pyonephrosis on a porcine model and a patient ：a case report

“…Plus, the commonly used X-ray and ultrasound have the inherent shortcomings. Therefore, it is important to find better measures to improve the puncture operation, with the aim to reduce intra-operative and post-operative complications and also be easy to learn [ 18 ].…”

Can trajectory nor‐epinephrine infiltration reduce blood loss during percutaneous nephrolithotomy? A double‐blinded randomized controlled trial

“…Percutaneous nephrolithotomy is the treatment of choice for bulky renal stones. The benchmark step of this procedure to be reproducible is the creation of a suitable tract that is associated with a great risk of bleeding 13 . The kidney is a highly vascular organ and the renal blood flow is about 1200 ml/min (∼400 ml/100 g renal‐tissue/min) which composes about ¼ of cardiac output 14 …”

“…The benchmark step of this procedure to be reproducible is the creation of a suitable tract that is associated with a great risk of bleeding. 13 The kidney is a highly vascular organ and the renal blood flow is about 1200 ml/ min ( $ 400 ml/100 g renal-tissue/min) which composes about ¼ of cardiac output. 14 Since the inception of the PCNL as an option for renal stones management, the procedure is continuously modified mainly to reduce access-associated AEs and bleeding.…”

Comparative evaluation of simulators for practising fluoroscopy-guided renal pelvic puncture

“…Пункция чашечно-лоханочной системы (ЧЛС) почки является одним из основных навыков эндоуролога, применяющихся как для установки нефростомического дренажа, так и для формирования чрескожного доступа при проведении перкутанной нефролитотрипсии (ПНЛ) [1]. Необходимо отметить, что формирование доступа при ПНЛ является наиболее сложным этапом.…”