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Percutaneous nephrolithotomy: technique

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Abstract

Percutaneous nephrolithotomy (PCNL) is considered to be the first line of treatment for large renal stones. Though PCNL comes with higher morbidity, its efficacy is unbeaten by other minimally invasive modalities. However, potential complications, such as bleeding, occur. Improved skills and modifications of the procedure may reduce the probability of adverse outcomes. This article discusses the current trends and standards in PCNL technique with special focus on all important steps as positioning, access, instruments, dilation, disintegration, and exit, including outcomes, complication management, and training modalities.

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References

  1. Agarwal M, Agrawal MS, Jaiswal A et al (2011) Safety and efficacy of ultrasonography as an adjunct to fluoroscopy for renal access in percutaneous nephrolithotomy (PCNL). BJU Int 108:1346–1349

    Article  PubMed  Google Scholar 

  2. Aghamir SM, Salavati A, Aloosh M et al (2012) Feasibility of totally tubeless percutaneous nephrolithotomy under the age of 14 years: a randomized clinical trial. J Endourol 26:621–624

    Article  PubMed  Google Scholar 

  3. Akman T, Binbay M, Aslan R et al (2012) Long-term outcomes of percutaneous nephrolithotomy in 177 patients with chronic kidney disease: a single center experience. J Urol 187:173–177

    Article  PubMed  Google Scholar 

  4. Al-Kohlany KM, Shokeir AA, Mosbah A et al (2005) Treatment of complete staghorn stones: a prospective randomized comparison of open surgery versus percutaneous nephrolithotomy. J Urol 173:469–473

    Article  PubMed  Google Scholar 

  5. Albala DM, Assimos DG, Clayman RV et al (2001) Lower pole I: a prospective randomized trial of extracorporeal shock wave lithotripsy and percutaneous nephrostolithotomy for lower pole nephrolithiasis-initial results. J Urol 166:2072

    Article  CAS  PubMed  Google Scholar 

  6. Alken P, Hutschenreiter G, Gunther R et al (1981) Percutaneous stone manipulation. J Urol 125:463

    Article  CAS  PubMed  Google Scholar 

  7. Andonian S, Scoffone CM, Louie MK et al (2013) Does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol 27:24–28

    Article  PubMed  Google Scholar 

  8. Andonian S, Scoffone CM, Louie MK et al (2012) Does imaging modality used for percutaneous renal access make a difference? A matched case analysis. J Endourol 27:24–28

    Google Scholar 

  9. Armitage JN, Irving SO, Burgess NA et al (2012) Percutaneous nephrolithotomy in the United kingdom: results of a prospective data registry. In:Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, United Kingdom. jim_armitage@hotmail.com, Switzerland, p 1188–1193

  10. Astroza G, Lipkin M, Neisius A et al (2013) Effect of supine vs prone position on outcomes of percutaneous nephrolithotomy in staghorn calculi: results from the Clinical Research Office of the Endourology Society Study. Urology 82:1240–1244

    Article  PubMed  Google Scholar 

  11. Bader MJ, Gratzke C, Seitz M et al (2011) The “All-Seeing Needle”: initial results of an optical puncture system confirming access in percutaneous nephrolithotomy. Eur Urol 59:1054–1059

    Article  Google Scholar 

  12. Bayrak O, Seckiner I, Erturhan S (2012) Evaluation of pediatric percutaneous nephrolithotomy experience of an adult-trained surgeon. In: Department of Urology, University of Gaziantep, Gaziantep, Turkey. Dromerbayrak@yahoo.com, United States, p 992–995

  13. Bhageria A, Nayak B, Seth A et al (2013) Paediatric percutaneous nephrolithotomy: Single-centre 10-year experience. In:Elsevier Ltd (Langford Lane, Kidlington, Oxford OX5 1 GB, United Kingdom), United Kingdom, p 472–475

  14. Bilen CY, Kocak B, Kitirci G et al (2007) Percutaneous nephrolithotomy in children: lessons learned in 5 years at a single institution. J Urol 177:1867–1871

    Article  PubMed  Google Scholar 

  15. Clayman RV, Preminger GM, Franklin JF et al (1985) Percutaneous ureterolithotomy. J Urol 133:671–673

    Article  CAS  PubMed  Google Scholar 

  16. Cracco CM, Scoffone CM, Poggio M et al (2010) The patient position for PNL: does it matter? Arch Ital Urol Androl 82:30–31

    PubMed  Google Scholar 

  17. De La Rosette JJ, Zuazu JR, Tsakiris P et al (2008) Prognostic factors and percutaneous nephrolithotomy morbidity: a multivariate analysis of a contemporary series using the Clavien classification. J Urol 180:2489–2493

    Article  Google Scholar 

  18. Dehong C, Liangren L, Huawei L et al (2013) A comparison among four tract dilation methods of percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 41:523–530

    Article  CAS  PubMed  Google Scholar 

  19. Desai J, Zeng G, Zhao Z et al (2013) A novel technique of ultra-mini-percutaneous nephrolithotomy: introduction and an initial experience for treatment of upper urinary calculi less than 2 cm. BioMed Res Int 2013:490793

    Article  PubMed  PubMed Central  Google Scholar 

  20. Desai MR, Kukreja RA, Desai MM et al (2004) A prospective randomized comparison of type of nephrostomy drainage following percutaneous nephrostolithotomy: large bore versus small bore versus tubeless. J Urol 172:565

    Article  PubMed  Google Scholar 

  21. Duty B, Waingankar N, Okhunov Z et al (2012) Anatomical variation between the prone, supine, and supine oblique positions on computed tomography: implications for percutaneous nephrolithotomy access. Urology 79:67–71

    Article  PubMed  Google Scholar 

  22. Ferakis N, Stavropoulos M (2015) Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature. Urol Ann 7:141–148

    Article  PubMed  PubMed Central  Google Scholar 

  23. Gupta M, Lee MW (2007) Treatment of stones associated with complex or anomalous renal anatomy. Urol Clin North Am 34:431–441

    Article  PubMed  Google Scholar 

  24. Hacker A, Wendt-Nordahl G, Honeck P et al (2007) A biological model to teach percutaneous nephrolithotomy technique with ultrasound- and fluoroscopy-guided access. J Endourol 21:545–550

    Article  PubMed  Google Scholar 

  25. Hammond L, Ketchum J, Schwartz BF (2004) A new approach to urology training: a laboratory model for percutaneous nephrolithotomy. J Urol 172:1950–1952

    Article  PubMed  Google Scholar 

  26. Hosseini SR, Mohseni MG, Alizadeh F (2014) One shot tract dilation for percutaneous nephrolithotomy: Is it safe and effective in preschool children? Urol Int 92(4):440–443

    Article  PubMed  Google Scholar 

  27. Ibarluzea G, Scoffone CM, Cracco CM et al (2007) Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int 100:233–236

    Article  PubMed  Google Scholar 

  28. Isac W, Rizkala E, Liu X et al (2013) Endoscopic-guided versus fluoroscopic-guided renal access for percutaneous nephrolithotomy: a comparative analysis. In:Stevan B. Streem Center for Endourology and Stone Disease, Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH 44195, USA., United States, p 251–256

  29. Kaufmann OG, Sountoulides P, Kaplan A et al (2009) Skin treatment and tract closure for tubeless percutaneous nephrolithotomy: University of California, Irvine, technique. J Endourol 23:1739–1741

    Article  PubMed  Google Scholar 

  30. Khan F, Borin JF, Pearle MS et al (2006) Endoscopically guided percutaneous renal access: “seeing is believing”. J Endourol 20:451–455 (discussion 455)

    Article  PubMed  Google Scholar 

  31. Knoll T (2014) Editorial comment for Zeng et al J Endourol 28:267–268

    Article  PubMed  Google Scholar 

  32. Knoll T, Wezel F, Michel MS et al (2010) Do patients benefit from miniaturized tubeless percutaneous nephrolithotomy? A comparative prospective study. J Endourol 24:1075–1079

    Article  PubMed  Google Scholar 

  33. Kukreja R, Desai M, Patel S et al (2004) Factors affecting blood loss during percutaneous nephrolithotomy: prospective study. J Endourol 18:715–722

    Article  PubMed  Google Scholar 

  34. Lahme S, Bichler KH, Strohmaier WL et al (2001) Minimally invasive PCNL in patients with renal pelvic and calyceal stones. Eur Urol 40:619

    Article  CAS  PubMed  Google Scholar 

  35. Lang E, Thomas R, Davis R et al (2009) Risks, advantages, and complications of intercostal vs subcostal approach for percutaneous nephrolithotripsy. Urology 74:751–755

    Article  PubMed  Google Scholar 

  36. Lee CL, Anderson JK, Monga M (2004) Residency training in percutaneous renal access: does it affect urological practice? J Urol 171:592–595

    Article  PubMed  Google Scholar 

  37. Li Y, Yang L, Xu P et al (2013) One-shot versus gradual dilation technique for tract creation in percutaneous nephrolithotomy: a systematic review and meta-analysis. Urolithiasis 41:443–448

    Article  PubMed  Google Scholar 

  38. Liatsikos EN, Kallidonis P, Stolzenburg JU et al (2010) Percutaneous management of staghorn calculi in horseshoe kidneys: a multi-institutional experience. J Endourol/Endourol Soc 24:531–536

    Article  Google Scholar 

  39. Lingeman JE, Siegel YI, Steele B et al (1994) Management of lower pole nephrolithiasis: a critical analysis. J Urol 151:663

    Article  CAS  PubMed  Google Scholar 

  40. Lojanapiwat B, Prasopsuk S (2006) Upper-pole access for percutaneous nephrolithotomy: comparison of supracostal and infracostal approaches. J Endourol 20:491–494

    Article  CAS  PubMed  Google Scholar 

  41. Mandal S, Goel A, Gupta DK (2012) Re: Jens J. Rassweiler, Michael Muller, Markus Fangerau, et al iPad-assisted percutaneous access to the kidney using marker-based navigation: initial clinical experience. Eur Urol 2012;61:628–31. In, Switzerland, pp e57–e58

  42. Marcovich R, Jacobson AI, Singh J et al (2004) No panacea for drainage after percutaneous nephrolithotomy. J Endourol 18:743–747

    Article  CAS  PubMed  Google Scholar 

  43. Meretyk S, Gofrit ON, Gafni O et al (1997) Complete staghorn calculi: random prospective comparison between extracorporeal shock wave lithotripsy monotherapy and combined with percutaneous nephrostolithotomy. J Urol 157:780–786

    Article  CAS  PubMed  Google Scholar 

  44. Michel MS, Knoll T, Kohrmann KU et al (2002) The URO Mentor: development and evaluation of a new computer-based interactive training system for virtual life-like simulation of diagnostic and therapeutic endourological procedures. BJU Int 89:174

    Article  CAS  PubMed  Google Scholar 

  45. Mishra S, Jagtap J, Sabnis RB et al (2013) Training in percutaneous nephrolithotomy. In:Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India. mishra@mpuh.org, United States, p 147–151

  46. Mishra S, Sharma R, Garg C et al (2011) Prospective comparative study of Miniperc and standard PNL for treatment of 1 to 2 cm size renal stone. BJU Int 108:896–900

    Google Scholar 

  47. Nagele U, Anastasiadis AG, Schilling DA et al (2007) Introducing a new sealant applicator for easy, safe, and quick closure of a mini-percutaneous nephrolitholapaxy access tract. J Endourol 21:393–396

    Article  PubMed  Google Scholar 

  48. Opondo D, Tefekli A, Esen T et al (2012) Impact of case volumes on the outcomes of percutaneous nephrolithotomy. In: Elsevier (P.O. Box 211, Amsterdam 1000 AE, Netherlands), Netherlands, p 1181–1187

  49. Osman M, Wendt-Nordahl G, Heger K et al (2005) Percutaneous nephrolithotomy with ultrasonography-guided renal access: experience from over 300 cases. BJU Int 96:875–878

    Article  PubMed  Google Scholar 

  50. Ritter M, Rassweiler MC, Hacker A et al (2012) Laser-guided percutaneous kidney access with the Uro Dyna-CT: first experience of three-dimensional puncture planning with an ex vivo model. World J Urol 31:1147–1151

    Google Scholar 

  51. Rodrigues PL, Rodrigues NF, Fonseca J et al (2013) Kidney targeting and puncturing during percutaneous nephrolithotomy: Recent advances and future perspectives. In: Mary Ann Liebert Inc. (140 Huguenot Street, New Rochelle NY 10801–5215, United States), United States, p 826–834

  52. Schilling D, Gakis G, Walcher U et al (2011) The learning curve in minimally invasive percutaneous nephrolitholapaxy: a 1-year retrospective evaluation of a novice and an expert. World J Urol 29:749–753

    Article  PubMed  Google Scholar 

  53. Scoffone CM, Cracco CM, Cossu M et al (2008) Endoscopic combined intrarenal surgery in Galdakao-modified supine Valdivia position: a new standard for percutaneous nephrolithotomy? Eur Urol 54:1393–1403

    Article  PubMed  Google Scholar 

  54. Segura JW, Patterson DE, Leroy AJ et al (1983) Percutaneous lithotripsy. J Urol 130:1051–1054

    Article  CAS  PubMed  Google Scholar 

  55. Shoma AM, Eraky I, El KMR et al (2002) Percutaneous nephrolithotomy in the supine position: technical aspects and functional outcome compared with the prone technique. Urology 60:388–392

    Article  PubMed  Google Scholar 

  56. Tanriverdi O, Boylu U, Kendirci M et al (2007) The Learning Curve in the Training of Percutaneous Nephrolithotomy. Eur Urol 10:10

    Google Scholar 

  57. Türk CK, Petrik A, Sarica K, Skolarikos A, Straub M, Seitz C (ed) (2015) Guideline on urolithiasis. European association of urology, Arnhem, The Netherlands

  58. Valdivia JG, Scarpa RM, Duvdevani M et al (2011) Supine versus prone position during percutaneous nephrolithotomy: a report from the clinical research office of the endourological society percutaneous nephrolithotomy global study. J Endourol 25:1619–1625

    Article  PubMed  Google Scholar 

  59. Valdivia Uria JG, Valle Gerhold J, Lopez Lopez JA et al (1998) Technique and complications of percutaneous nephroscopy: experience with 557 patients in the supine position. J Urol 160:1975–1978

    Article  CAS  PubMed  Google Scholar 

  60. Wezel F, Mamoulakis C, Rioja J et al (2009) Two contemporary series of percutaneous tract dilation for percutaneous nephrolithotomy. J Endourol 23:1655–1661

    Article  PubMed  Google Scholar 

  61. Zhong Q, Zheng C, Mo J et al (2013) Total tubeless versus standard percutaneous nephrolithotomy: A meta-analysis. In:Mary Ann Liebert Inc. (140 Huguenot Street, New Rochelle NY 10801–5215, United States), United States, p 420–426

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Author information

Authors and Affiliations

  1. Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tuebingen, Tuebingen, Germany

    Thomas Knoll

  2. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Francisco Daels

  3. Samved Hospital, Ahmedabad, India

    Janak Desai

  4. Hopital Henri Mondor, Créteil, France

    Andras Hoznek

  5. Wexner Medical Center, The Ohio State University, Columbus, USA

    Bodo Knudsen

  6. Hospital Santi e Carlo, Milano, Italy

    Emanuele Montanari

  7. Cottolengo Hospital, Torino, Italy

    Cesare Scoffone

  8. National and Kapodistrian University of Athens, Sismanogleio General Hospital, Athens, Greece

    Andreas Skolarikos

  9. Department of Urology, Klinikum Sindelfingen-Boeblingen, Nagoya City University, Nagoya, Japan

    Keiichi Tozawa

Authors
  1. Thomas Knoll
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  2. Francisco Daels
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  3. Janak Desai
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  4. Andras Hoznek
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  6. Emanuele Montanari
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  7. Cesare Scoffone
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  9. Keiichi Tozawa
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Corresponding author

Correspondence to Thomas Knoll.

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The manuscript does not contain clinical studies or patient data.

Conflict of interest

T Knoll: Boston Scientific (Speaker, Advisory board), Karl Storz Endoscopes(Live surgeon, courses), Olympus (Advisory board). F Daels: None, J Desai: LUT/Schoelly (Speaker, Advisor), A Hoznek: None, B Knudsen: None, E Montanari: None, C Scoffone: None, A Skolarikos: None, K Tozawa: None.

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Knoll, T., Daels, F., Desai, J. et al. Percutaneous nephrolithotomy: technique. World J Urol 35, 1361–1368 (2017). https://doi.org/10.1007/s00345-017-2001-0

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  • DOI: https://doi.org/10.1007/s00345-017-2001-0

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