European Association of Urology Section of Urolithiasis and International Alliance of Urolithiasis Joint Consensus on Percutaneous Nephrolithotomy

Guohua Zeng, Wen Zhong, Margaret Pearle, Simon Choong, Ben Chew, Andreas Skolarikos, Evangelos Liatsikos, Shashi Kiran Pal, Sven Lahme, Otas Durutovic, Yasser Farahat, Sanjay Khadgi, Mahesh Desai, Thomas Chi, Daron Smith, Andras Hoznek, Athanasios Papatsoris, Janak Desai, Giorgio Mazzon, Bhaskar SomaniBrian Eisner, Cesare Marco Scoffone, Dong Nguyen, Stefania Ferretti, Guido Giusti, Iliya Saltirov, Marcus Vinicius Maroccolo, Mehmet Ilker Gökce, Michael Straub, Norberto Bernardo, Pedro Laki Lantin, Sherjeel Saulat, Wael Gamal, John Denstedt, Zhangqun Ye, Kemal Sarica

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish (US)
JournalEuropean Urology Focus
DOIs
StateAccepted/In press - 2021

Keywords

  • Expert consensus
  • PCNL
  • Percutaneous nephrolithotomy

ASJC Scopus subject areas

  • Urology

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