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Percutaneous Management of Large Renal Calculi (Percutaneous Nephrolithotomy)

  • Karen L. SternEmail author
  • Shubha De
  • Manoj Monga
Chapter

Abstract

Percutaneous nephrolithotomy (PCNL) is the current standard of care for patients with a large stone burden. There are varying ways to perform PCNL, including different patient positioning, percutaneous access methods, and instrumentation. Endoscopic-guided percutaneous access in the prone split leg position combines flexible ureteroscopy with fluoroscopy to perform the renal puncture and tract dilation. This technique allows careful consideration of the renal anatomy and stone position. Pre-puncture stone manipulation can help simplify nephroscopy by repositioning stones from hard-to-reach calyces. This chapter will cover the indications and exclusion criteria for percutaneous surgery, while detailing the necessary equipment, positioning, and step-by-step methods to achieve endoscopic-guided renal access.

Keywords

Percutaneous nephrolithotomy Renal access Endoscopic-guided renal access Lithotripsy Nephrolithiasis 

References

  1. 1.
    American Urological Association. Endourological Society. Surgical Management of Stones: AUA/Endourology Society Guideline 2016. [Online]. http://www.auanet.org/guidelines/surgical-management-of-stones-(aua/endourological-society-guideline-2016). Accessed 16 Nov 2018.
  2. 2.
    Leavitt DA, Theckumparampil N, Moreira DM, Elsamra SE, Waingankar N, Hoenig DM, et al. Continuing aspirin therapy during percutaneous nephrolithotomy: unsafe or under-uitilized? J Endourol. 2014;28(12):1399–403.CrossRefGoogle Scholar
  3. 3.
    Yuan D, Liu Y, Rao H, Cheng T, Sun Z, Wang Y, et al. Supine versus prone position in percutaneous nephrolithotomy for kidney calculi: a meta-analysis. J Endourol. 2016;30(7):754–63.CrossRefGoogle Scholar
  4. 4.
    Ibarluzea G, Scoffone CM, Cracco CM, Poggio M, Porpiglia F, Terrone C, et al. Supine Valdivia and modified lithotomy position for simultaneous anterograde and retrograde endourological access. BJU Int. 2007;100(1):233–6.CrossRefGoogle Scholar
  5. 5.
    Friedlander JI, Duty BD, Smith AD, Okeke Z. Percutaneous nephrostolithotomy: an assessment of costs for prone and Galdakao-modified supine Valdivia positioning. Urology. 2012;80(4):771–5.CrossRefGoogle Scholar
  6. 6.
    Yang YH, Wen YC, Chen KC, et al. Ultrasound-guided versus fluoroscopy-guided percutaneous nephrolithotomy: a systematic review and meta-analysis. World J Urol. 2018;  https://doi.org/10.1007/s00345-018-2443-z. [Epub ahead of print].CrossRefGoogle Scholar
  7. 7.
    Ng FC, Yam WL, Lim TYB, Teo JK, Ng KK, Lim SK. Ultrasound-guided percutaneous nephrolithotomy: advantages and limitations. Investig Clin Urol. 2017;58(5):346–52.CrossRefGoogle Scholar
  8. 8.
    Traxer O, Smith TG 3rd, Pearle MS, Corwin TS, Saboorian H, Cadeddu JA. Renal parenchymal injury after standard and mini percutaneous nephrostolithotomy. J Urol. 2001;165(5):1693–5.CrossRefGoogle Scholar
  9. 9.
    Loftus CJ, Hinck B, Makovey I, Sivalingam S, Monga M. Mini versus standard percutaneous nephrolithotomy: the impact of sheath size on intrarenal pelvic pressure and infectious complications in a porcine model. J Endourol. 2018;32(4):350–3.CrossRefGoogle Scholar
  10. 10.
    De S, Autorino R, Kim FJ, Zargar H, Laydner H, Balsamo R, et al. Percutaneous nephrolithotomy versus retrograde intrarenal surgery: a systematic review and meta-analysis. Eur Urol. 2015;67(1):125–37. Erratum in Eur Urol. 2016:69(4):e85.CrossRefGoogle Scholar
  11. 11.
    Labate G, Modi P, Timoney A, Cormio L, Zhang X, Louie M, et al. The percutaneous nephrolithotomy global study: classification of complications. J Endourol. 2011;25(8):1275–80.CrossRefGoogle Scholar
  12. 12.
    de la Rosette J, Assimos D, Desai M, et al. The Clinical Research Office of Endourological Society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5803 patients. J Endourol. 2011;25:11–7.CrossRefGoogle Scholar
  13. 13.
    Altschuler J, Jain R, Monga M. Supracostal upper pole endoscopic-guided prone tubeless “Maxi-PCNL”: a contemporary evaluation of complications. J Endourol. 2018;  https://doi.org/10.1089/end.2018.0502. [Epub ahead of print].CrossRefGoogle Scholar
  14. 14.
    Tefekli A, Esen T, Olbert PJ, Tolley D, Nadler RB, Sun YH, et al.; CROES PCNL Study Group. Isolated upper pole access in percutaneous nephrolithotomy: a large-scale analysis from the CROES percutaneous nephrolithotomy global study. J Urol. 2013;189(2):568–73.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandUSA
  2. 2.Department of UrologyMayo ClinicPhoenixUSA
  3. 3.Division of Urology, Department of SurgeryNorthern Alberta Urology Centre, University of AlbertaEdmontonCanada

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