World-wide variation in percutaneous nephrolithotomy practices: evaluation based on training, experience, and region

Area of Science:

• Urology
• Minimally Invasive Surgery
• Medical Technology Adoption

Background:

• Percutaneous nephrolithotomy (PCNL) has seen innovations aimed at reducing invasiveness.
• Global adoption rates of these PCNL advancements are not well understood.
• Regional and educational disparities may influence the uptake of new PCNL technologies.

Purpose of the Study:

• To investigate the worldwide adoption of recent advances in percutaneous nephrolithotomy (PCNL).
• To compare the influence of geographic region and professional education on PCNL practice patterns.
• To identify variations in PCNL techniques and technology use across different global areas.

Main Methods:

• An anonymous 32-item survey was distributed globally via the Endourological Society's Twitter/X account.
• Data collected included participant geography, PCNL volume, fellowship training, and specific PCNL practices.
• Descriptive statistics and chi-square/Fisher's exact tests were used for comparative analysis.

Main Results:

• 160 PCNL providers responded, showing regional variations in anesthesia (spinal in Asia) and positioning (supine in Europe).
• Energy source preferences (pneumatic vs. dual energy) and tract agent use differed between regions (Asia vs. North America/Europe).
• High-volume providers and experienced surgeons were more likely to use mini-PCNL techniques; postoperative imaging varied by region and training.

Conclusions:

• Significant worldwide variations in PCNL practices exist, influenced by regional, economic, and experiential factors.
• A notable shift towards supine positioning (41%) and tubeless PCNL (>50%) is evident.
• Widespread adoption of ultrasound for access remains limited (73% use fluoroscopy), indicating a need for further research and standardization.