[Percutaneous nephrolithotomy in 1984. Technics, results, indications].

Percutaneous nephrolithotomy - PCNL - was made possible by technological progress, with the introduction of nephroscopes, lithotomy forceps, and mechanical, ultrasonic or electrohydraulic lithotriptors. The procedure includes four stages. First needle puncture of the inferior or middle calyx. Secondly, dilatation of the pathway and creation of a tunnel. Thirdly, investigation of the collecting system. And, finally, extraction of the stone. The results of 302 published cases show a success rate of 87 per cent, a complete failure rate of 13 per cent, and residual stones in 10 per cent of cases. The complication rate is 7 per cent, with hemorrhage and sepsis in roughly equal proportions. A few other complications are occasionally reported, such as colic wounds, perirenal collections, traumas of the ureteropelvic junction, pneumothorax, or a stone left in the lumbar wall. There was one case of death. The hospitalization period is the same as for lombotomy, but the return to work is more rapid. The best indications are pelvic and inferior calyceal stones (with a success rate of over 80 per cent). Despite their enthusiasm for this procedure, the authors feel that is still remains to be seen or whether it will in turn be superseded by ultrasound lithotripsy.