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Percutaneous nephrolithotomy (PCNL) a critical review.
Arvind P Ganpule1, Mohankumar Vijayakumar1, Ankur Malpani1
1Department of Urology, Muljibhai Patel Urological Hospital, Nadiad 387001, Gujarat, India.
Percutaneous nephrolithotomy (PCNL) offers an effective method for kidney stone removal. Advances in miniaturization have reduced complications without compromising stone clearance rates.
Area of Science:
- Urology
- Endourology
Background:
- Percutaneous nephrolithotomy (PCNL) is the primary treatment for kidney stones.
- PCNL techniques have significantly evolved since their introduction.
Purpose of the Study:
- To review the evolution and current status of PCNL for renal calculi.
- To highlight advancements in PCNL, focusing on miniaturization and its impact on outcomes.
Main Methods:
- Review of PCNL approaches including supine and prone positions.
- Discussion of imaging guidance (fluoroscopy, ultrasound) and newer endoscopic techniques.
- Analysis of tract size reduction and its implications.
Main Results:
- Traditional PCNL used larger tracts (30Fr), associated with complications like bleeding.
- Miniaturization of PCNL tracts has reduced complications.
- Stone clearance rates remain high with reduced tract sizes.
Conclusions:
- PCNL is a highly efficient procedure for stone removal, though skill-dependent.
- Minimally invasive approaches should prioritize stone clearance.
- The choice of PCNL technique depends on surgeon expertise and patient factors.
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