2022 Recommendations of the AFU Lithiasis Committee: Percutaneous nephrolithotomy

Area of Science:

• Urology
• Nephrology
• Surgical Procedures

Background:

• Percutaneous nephrolithotomy (PCNL) is the standard treatment for large kidney stones (≥2cm).
• Patient positioning can be prone or modified supine, with image guidance (fluoroscopy/ultrasound).

Purpose of the Study:

• To provide recommendations on PCNL for large kidney stones.
• To evaluate techniques, outcomes, and adjuncts for PCNL.

Main Methods:

• Recommendations developed using Clinical Practice Recommendation (CPR) and ADAPTE methods.
• Adaptation of European Association of Urology (EAU) guidelines for the French context.

Main Results:

• Stone-free rates appear comparable between miniaturized and standard PCNL.
• Smaller instruments reduce blood loss but may increase procedure time.
• Limiting percutaneous tracts preserves kidney function and reduces complications.
• Tranexamic acid may decrease bleeding, transfusion rates, and intervention duration.

Conclusions:

• PCNL techniques, including miniaturized approaches, are effective for large kidney stones.
• Minimizing access tracts and considering tranexamic acid are key to optimizing outcomes and patient safety.