Current trends of percutaneous nephrolithotomy in a developing country

Area of Science:

• Urology
• Endourology
• Surgical Techniques

Background:

• Percutaneous nephrolithotomy (PCNL) is a key procedure for kidney stone management.
• Understanding current practice patterns is crucial for improving PCNL in developing countries.

Purpose of the Study:

• To delineate contemporary percutaneous nephrolithotomy (PCNL) practice patterns among Brazilian urologists.
• To identify trends in surgical positioning, access, lithotripsy, and postoperative care.

Main Methods:

• A survey was administered to Brazilian urologists at the II International Endourology Symposium in 2015.
• The survey collected demographic data and detailed information on PCNL techniques from performing urologists.

Main Results:

• 81% of respondents performed PCNL, with most trained during residency. The prone position was preferred, especially by older surgeons, while younger surgeons favored the supine position.
• Fluoroscopy was the primary guidance method for access, with ultrasonic lithotripsy being common. Nephrostomy tubes were frequently used for drainage.
• Colonic injury was reported by 25% of surgeons, with a higher incidence in the senior group.

Conclusions:

• Brazilian urologists typically perform PCNL access independently using fluoroscopy, predominantly in the prone position.
• Current practices involve fascial dilators, ultrasonic lithotripsy, and nephrostomy tubes.
• There is a need to promote fellowship training, ultrasonography, flexible nephroscopy, and tubeless PCNL procedures.