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Percutaneous nephrolithotomy (PCNL) a critical review

Percutaneous nephrolithotomy (PCNL) is the preferred treatment of choice for renal calculi. PCNL has evolved remarkably since the eighties when it was first described. The indications have changed over the years with the introduction of others techniques such as extracorporeal shockwave lithotripsy (ESWL) and flexible ureteroscopy. In the early years, large stones were treated with PCNL and smaller ones left for ESWL. The concepts have changed in context to miniaturization of instruments and advancements in energy and optics where even smaller stones are treated with PCNL with minimal morbidity and better stone clearance rates.

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Articles of Interest

Endoscopic Guided Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PCNL) is the treatment of choice for kidney stones >2 cm in size. Obtaining a nephrostomy tract to access the kidney is a key step in this procedure that ultimately determines the patient's outcome.

Percutaneous Nephrolithotomy (Keyhole Surgery for Kidney Stones)

The aim of this procedure is to fragment stones in the kidney telescopically using a “keyhole” approach to your kidney through a puncture in the skin of your back. It is a major procedure and is usually reserved for larger stones or for patients with complex kidney anatomy. We puncture the kidney with a needle, under ultrasound or X-ray guidance, and stretch up a “track” into the kidney through which we can pass a telescope. The stone is broken up using a laser fibre, a lithoclast (small pneumatic drill) or an ultrasonic suction probe. This procedure has largely eliminated the need for open surgery to remove kidney stones, because there is a similar stone clearance rate and recovery is much faster.

Percutaneous Nephrolithotomy (PCNL)

Your doctor may recommend PCNL surgery if you have a large, multiple or complex stones. The surgery lasts one to three hours and typically requires a hospital stay of one to two nights. You should be able to resume normal activities in one to two weeks.

Percutaneous nephrolithotomy: Current concepts

Percutaneous nephrolithotomy (PNL) is the procedure of choice for large renal stones. Since its introduction in 1976, many aspects of the operative technique and the endoscopic equipments have had constant evolution, increasing the success rates of the procedure.

Percutaneous Nephrolithotomy: Update, Trends, and Future Directions

Our understanding of PCNL has vastly improved through the study of population-based data sources and registries that have provided a wealth of outcome information.

Technique of Percutaneous Nephrolithotomy

As open renal stone surgery has decreased in utilization, percutaneous nephrolithotomy (PNL) has increased over recent years. According to the 2016 American Urological Association Surgical Management of Stones Guidelines, PNL should be offered as first-line therapy to patients with over 20 mm of total renal stone burden due to the improved stone-free rates and outcomes in these patients.

Resources

National Kidney Foundation

These procedures are treatments for kidney stones that are used in patients with large or irregularly shaped kidney stones, people with infections, stones that have not been broken up enough by SWL (extracorporeal shock wave lithotripsy) or those who are not candidates for another common stone treatment, ureteroscopy. Stones that are bigger than 2 cm (the size of a marble) require this procedure.