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

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.

Introduction

Urolithiasis is one of the most common diseases in benign urological conditions. The prevalence of urolithiasis ranges from 1% to 20% worldwide according to the most recent epidemiological surveys [1], [2].

Percutaneous nephrolithotomy (PCNL) has been a well-established procedure in the management of upper urinary tract stones >2 cm [3], [4], [5]. Although PCNL has been performed for decades and has gone through many refinements, there are still concerns regarding more widespread utilization because of the long learning curve and the potential risk of severe complications. Several urological associations, including American Urological Association (AUA), European Association of Urology (EAU), and Chinese Urology Association, have released corresponding guidelines [6], [7], but many technical details of PCNL are not included in the guidelines because of their nature and research protocol.

Given the safety and effectiveness of PCNL, a global consensus on indications, preoperative patient preparation, surgical strategy, prevention and management of severe complications, postoperative management, and follow-up is certainly desirable [8]. In order to standardize the procedure and make it more acceptable, the Urolithiasis Section of the EAU (EULIS) and the International Alliance of Urolithiasis (IAU) present a joint consensus on PCNL.