Preoperative percutaneous stone surgery in patients receiving anticoagulant therapy

Percutaneous nephrostolithotomy (PCNL) is an essential component in the management of large volume renal calculi. Either in combination with shockwave lithotripsy but especially as monotherapy, PCNL is recommended as the most effective treatment option for patients with staghorn calculi or large volume stone disease. Multiple tracts allow successful management of nearly every stone burden in a single surgical session. Furthermore, patients with anatomic variations (eg, horseshoe kidney) can be treated by PCNL successfully. Overall stone-free rates of above 78% are described. With the rising age of the overall patient population, another problem occurs. Increasing age frequently leads to an increase in comorbidities; for example, patients receiving anticoagulation may need treatment for stones, which can pose a dilemma. The aim of this review was to provide an overview of thrombotic risk, depending on the underlying disease, and to propose a clinical pathway on how to deal with this selected group of patients.