New developments in percutaneous techniques for simple and complex branched renal stones

• Published in: Current opinion in urology Vol. 21; no. 2; p. 154
• Main Authors: Cracco, Cecilia M, Scoffone, Cesare M, Scarpa, Roberto M
• Format: Journal Article
• Language: English
• Published: United States 01.03.2011
• Subjects: Humans; Kidney Calculi - therapy; Lithotripsy, Laser; Nephrostomy, Percutaneous - methods; Nephrostomy, Percutaneous - trends; Patient Positioning; Treatment Outcome
• ISSN: 1473-6586
• DOI: 10.1097/MOU.0b013e3283436d32

Percutaneous nephrolithotomy (PNL), although practiced for almost 30 years, is still the most appropriate treatment modality for several forms of renal stones. We analysed a number of very recent advances in PNL technique, contributing to the continuous improvement of its efficacy and safety. A thorough review of the recent literature identifies five major progressing areas, inspiring fruitful innovations in PNL technique: imaging (computed tomography being the standard tool) before, during and after the procedure; patient positioning (the traditional prone position being now challenged with the emerging supine positions); endoscopic combined intrarenal surgery (ECIRS), a versatile antero-retrograde approach to the upper urinary tract and a new comprehensive attitude of the urologist toward the various PNL steps; intracorporeal lithotripsy (improved by new devices combining ultrasonic and pneumatic lithotripsy, or ultrasonic and high-power holmium: YAG laser lithotripsy); and post-PNL tube management (namely nephrostomy-free and totally tubeless procedures). Urologists dedicate significant efforts to the improvement of the PNL procedure, with the aim of further increasing its stone-free outcomes and reducing patient morbidity. Large-scale multicentre prospective trials are needed to define benefits and identify possible drawbacks of the described innovations in percutaneous stone management.