Recent advancement or less invasive treatment of percutaneous nephrolithotomy

Abstract

Since its initial introduction in 1976, percutaneous nephrolithotomy (PCNL) has been widely performed for the management of large renal stones and currently is recommended for staghorn calculi, kidney stones larger than 2 cm, and shock wave lithotripsy-resistant lower pole stones greater than 1 cm. However, except for open and laparoscopic surgery, PCNL is the most invasive of the minimally invasive stone surgery techniques. Over the years, technical and instrumental advances have been made in PCNL to reduce morbidity and improve effectiveness. A thorough review of the recent literature identified five major areas of progress for the advancement of PCNL: patient positioning, method of percutaneous access, development of lithotriptors, miniaturized access tracts, and postoperative nephrostomy tube management. This review provides an overview of recent advancements in PCNL and the outcomes of each area of progress and notes how much we achieve with less invasive PCNL. This information may allow us to consider the future role and future developments of PCNL.

Keywords: Kidney calculi; Minimally invasive surgical procedures; Percutaneous nephrostomy; Supine position; Surgical instruments.

Fig. 1. Schematic images of percutaneous access for percutaneous nephrolithotomy (PCNL) in the supine position. The position is usually modified by using a saline bag or a specially made cushion below the ipsilateral upper flank, except in the complete supine position PCNL. (A) Transverse view, (B) lateral view. Arrow indicates direction of percutaneous access.