(1)
University of Melbourne and Austin Health, Melbourne, VIC, Australia
Introduction
Percutaneous nephrolithotomy (PCNL) is endoscopic surgery of the kidney, almost exclusively to remove renal calculi, through a nephrocutaneous conduit established radiologically at the time of surgery.
The nephrocutaneous conduit can measure up to 32 FG, in other words just over a centimetre in diameter (Fig. 5.1).
Fig. 5.1
Schematic PCNL
Mini PCNL is PCNL using smaller instruments through a narrower conduit of 20 FG or approximately 7 mm in diameter, down to 14–16.
Indications for Surgical Treatment of Renal Calculi
Pain (ongoing)
Obstruction
Stone-associated infection
Stones associated with decreased renal function
Stone causing anuria
Obstructive urosepsis
Occupation (airline pilot, heavy machinery driver, traveller to remote regions etc.)
Others (transplant, organ donors)
Options for the Treatment of Renal Calculi
Extracorporal shockwave lithotripsy (ESWL)
Percutaneous nephrolithotomy (PCNL)
Retrograde flexible ureterorenoscopic laser lithotripsy (FURS)
Nephrolithotomy, ureterolithiotomy or nephrectomy
Open
Laparoscopic
Robot-assisted
Oral dissolution
Conservative management
Indications for PCNL
The most appropriate stones for treatment by a PCNL are those that cannot be removed by ESWL, retrograde ureteroscopy, other forms of nephrolithotomy or when these procedures have failed.
Indications for PCNL
Staghorn calculi—large stone burden (>2.5 or 1.5 cm in the lower pole)
Calculi contained within an obstructed collecting system (narrow PUJ, poorly draining lower pole calyces with narrow infundibulum, calculi within a horseshoe kidney)
Infection-associated calculi, which require 100% clearance to prevent recurrent infection
Complex stones in urinary diversion (e.g. ileal conduit diversions) with large stone mass, infection and poor drainage
Calculi refractory to ESWL, including cystine, brushite, calcium-oxalate and monohydrate calculi
Calculi that require 100% clearance for occupational regulations (airline pilots, military personnel, etc.)
Congenital malformations with poor drainage e.g. calyceal diverticulae, horse-shoe kidney)
Very large calculi impacted at or just below the pelviureteric junction and within the upper ureter, which are unsuitable for ureteroscopyRelated posts:
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