Guohua Zeng1, Wen Zhong1, Margaret Pearle2, Simon Choong3, Ben Chew4, Andreas Skolarikos5, Evangelos Liatsikos6, Shashi Kiran Pal7, Sven Lahme8, Otas Durutovic9, Yasser Farahat10, Sanjay Khadgi11, Mahesh Desai12, Thomas Chi13, Daron Smith3, Andras Hoznek14, Athanasios Papatsoris15, Janak Desai16, Giorgio Mazzon17, Bhaskar Somani18, Brian Eisner19, Cesare Marco Scoffone20, Dong Nguyen21, Stefania Ferretti22, Guido Giusti23, Iliya Saltirov24, Marcus Vinicius Maroccolo25, Mehmet Ilker Gökce26, Michael Straub27, Norberto Bernardo28, Pedro Laki Lantin29, Sherjeel Saulat30, Wael Gamal31, John Denstedt32, Zhangqun Ye33, Kemal Sarica34. 1. Department of Urology and Guangdong Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. 2. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. 3. Institute of Urology, University College Hospital, London, UK. 4. Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada. 5. 2nd Department of Urology, Sismanoglio General Hospital, Athens, Greece. 6. Department of Urology, University Hospital of Patras, University of Patras, Patras, Greece. 7. Department of Urology, Holy Family Hospital, New Delhi, India. 8. Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, Germany. 9. Department of Urology, Clinic of Urology, University of Belgrade, Belgrade, Serbia. 10. Department of Urology, Sheikh Khalifa General Hospital, Umm Al Quwain, United Arab Emirates. 11. Department of Urology, Vayodha Hospital, Kathmandu, Nepal. 12. Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India. 13. Department of Urology, University of California, San Francisco, CA, USA. 14. Department of Urology, Mondor Hospital, Créteil, France. 15. Department of Urology, Sismanoglio General Hospital, Athens, Greece. 16. Department of Urology, Samved Hospital, Ahmedabad, India. 17. Department of Urology, San Bassiano Hospital, Vicenza, Italy. 18. Department of Urology, University Hospital Southampton, Southampton, UK. 19. Deparment of Urology, Massachusetts General Hospital, Boston, MA, USA. 20. Department of Urology, Cottolengo Hospital of Torino, Torino, Italy. 21. Binh Dan Hospital, SaiGon, Vietnam. 22. Department of Urology, Hospital and University of Parma, Parma, Italy. 23. Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy. 24. Department of Urology and Nephrology, Military Medical Academy, Sofia, Bulgaria. 25. Hospital de Base of the Federal District, Brasília, Brazil. 26. Department of Urology, Ankara University School of Medicine, Ankara, Turkey. 27. Department of Urology, Technical University Munich, Munich, Germany. 28. Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina. 29. Urology Center of the Philippines, Quezon City, Philippines. 30. Department of Urology, Sindh Institution of Urology and Transplantation, Karachi, Pakistan. 31. Department of Urology, Sohag University Hospital, Sohag, Egypt. 32. Division of Urology, Western University, London, Ontario, Canada. 33. Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Electronic address: zhangqunye@163.com. 34. Department of Urology, Biruni University, Medical School, Istanbul, Turkey. Electronic address: saricakemal@gmail.com.
Abstract
CONTEXT: Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. OBJECTIVE: To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. EVIDENCE ACQUISITION: An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. EVIDENCE SYNTHESIS: The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. CONCLUSIONS: Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. PATIENT SUMMARY: Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist's experience, are critical to the safety and effectiveness of PCNL.
CONTEXT: Although percutaneous nephrolithotomy (PCNL) has been performed for decades and has gone through many refinements, there are still concerns regarding its more widespread utilization because of the long learning curve and the potential risk of severe complications. Many technical details are not included in the guidelines because of their nature and research protocol. OBJECTIVE: To achieve an expert consensus viewpoint on PCNL indications, preoperative patient preparation, surgical strategy, management and prevention of severe complications, postoperative management, and follow-up. EVIDENCE ACQUISITION: An international panel of experts from the Urolithiasis Section of the European Association of Urology, International Alliance of Urolithiasis, and other urology associations was enrolled, and a prospectively conducted study, incorporating literature review, discussion on research gaps (RGs), and questionnaires and following data analysis, was performed to reach a consensus on PCNL. EVIDENCE SYNTHESIS: The expert panel consisted of 36 specialists in PCNL from 20 countries all around the world. A consensus on PCNL was developed. The expert panel was not as large as expected, and the discussion on RGs did not bring in more supportive evidence in the present consensus. CONCLUSIONS: Adequate preoperative preparation, especially elimination of urinary tract infection prior to PCNL, accurate puncture with guidance of fluoroscopy and/or ultrasonography or a combination, keeping a low intrarenal pressure, and shortening of operation time during PCNL are important technical requirements to ensure safety and efficiency in PCNL. PATIENT SUMMARY: Percutaneous nephrolithotomy (PCNL) has been a well-established procedure for the management of upper urinary tract stones. However, according to an expert panel consensus, core technical aspects, as well as the urologist's experience, are critical to the safety and effectiveness of PCNL.
Authors: Otaš Durutović; Aleksandar Filipović; Katarina Milićević; Bhaskar Somani; Esteban Emiliani; Andreas Skolarikos; Milica M Janković Journal: Front Surg Date: 2022-05-03