Present indications and techniques of percutaneous nephrolithotomy: What the future holds?

Abstract

The purpose of the review was to present the latest updates on percutaneous nephrolithotomy (PCNL) procedure in terms of indications and evolving techniques, and to identify the advantages and disadvantages of each modality. The data for this review were collected after a thorough PubMed search in core clinical journals in English language. The key words included “PCNL” and “PNL” in combination with “indications”, “techniques”, “review” and “miniaturized PCNL”. Publications relevant to the subject were retrieved and critically reviewed. Current European and American Urology Association Nephrolithiasis Guidelines were included as well. The indications for standard PCNL have been changed through the past decade. Despite evolution of the procedure, innovations and the development of new technical approaches, the indications for miniaturized PCNL have not been standardized yet. There is a need for well-constructed randomized trials to explore the indications, complications and results for each evolving approach. A continuous reduction of tract size is not the only revolution of the last years. There is constant ongoing interest in developing new efficient miniature instruments, intracorporeal lithotripters and sophisticated tract creation methods. We can summarize that, PCNL represents a valuable well-known tool in the field of endourology. We should be open minded to future changes in surgical approaches and technological improvements.

Ultrasound-Guided Access in a Malrotated Kidney: Optimally Safe and Effective

“…1 The altered orientation of the kidney can make stone removal by percutaneous nephrolithotomy (PCNL) difficult, but studies have also shown that it can be a safe procedure as long as careful preoperative and postoperative planning is undertaken. [2][3][4] Alternatively, pyelolithotomy may be considered, which can take advantage of the anterior facing renal pelvis, but is more invasive and morbid, with concomitant risk for abdominal injury. Other viable options for stone removal in malrotated kidneys include flexible ureteroscopic lithotripsy and mini-PCNL; however, because of the significantly large stone burden, severe hydronephrosis, and anatomic complexity of our patient, these methods were not pursued further.…”

Research Article Results of 300 сases of mini - percutaneous nephrolithotomy at the Thanh Hoa General Hospital in Vietnam

“…The changes in PCNL techniques included not only decrease of the working instruments diameter but also improvement of patient positioning, safer and more accurate tract creation techniques, new imaging modalities, evolvement of intracorporeal lithotripters and incorporation of flexible instruments for efficient collecting system screening (Sabler et al, 2018).…”

Pre-operative Percutaneous Nephrolithotripsy Characterisation of Kidney Stones with Second-Generation Dual-Source Dual-Energy Computed Tomography

“…Kidney stones such as brushite (a unique calcium phosphate stone), calcium oxalate monohydrate and cystine should be treated by pre-operative percutaneous nephrolithotripsy (PCNL) or retrograde intrarenal surgery (RIRS) ( 12 ). Dual-energy computed tomography (DECT) is a reliable method to determine kidney stone composition in vivo ( 13 – 16 ) and in vitro ( 17 – 20 ).…”