PCNL: what's changed?

Abstract

PCNL is a endourological technique for the treatment of kidney stones disease. It's aim is to achieve the complete clearance via a percutaneous access. This technique, as we know it today, was developed by Johanson and Fernstrom in 1976 who used the technological advances in percutaneous fluoroscopy to get the percutaneous access. Following the application of various sources of energy for the fragmentation of the calculi such as ultrasound energy, there was the worldwide diffusion of PCNL thanks to Alken and Marbergen in Europe, Segura and Clayman in the USA. Despite in the early '80s the PCNL lost the initial impulse in favor of the SWL, in the '90s, it revived a second golden age through the application of emerging technologies such as computed tomography, techniques of obtaining the percutaneous access, flexible instrumentation, laser energy and, more recently, robotic surgery, and virtual reality. All of these contributed to bring the PCNL on the road up of the mini-invasiveness to the latest development of Microperc. The Microperc allows the treatment of stones of 2 cm in diameter also, obtaining the access under ultrasound, fluoroscopic and direct vision guidance. A complete system including micor-optics, laser fiber and irrigation system is then inserted into the same needle with a diameter of 4.85, 8 or 10 Fr The CROES used logistic developments by creating a global network and a multi-center database. The PCNL study, concluded in 2009, has led to the publication of as many as 27 scientific papers on this subject.