The American Urological Association Guidelines recommend percutaneous nephrolithotomy
(PCNL) as the standard of care for patients with staghorn or large renal stones because
of the high stone-free rates (SFRs) with minimal morbidity.
1
Before the advent of flexible fiberoptic instruments and Holmium laser lithotripters,
it was not unusual for PCNL to require multiple access tracts directly on calyces
containing stones to achieve stone-free status. Some authors even suggested performing
auxiliary procedures, such as shock wave lithotripsy (SWL) as combination or “sandwich”
therapy with PCNL to fragment stones that could not be reached using rigid instruments.
However, SFRs were lower when SWL was not followed with PCNL to remove stone fragments.
With the invention of flexible nephroscopes and ureteroscopes in addition to the availability
of flexible miniaturized lithotripters, such as Holmium laser using 200- or 365-μm
fibers, PCNL through a single incision and a single tract (sPCNL) becomes possible
for large renal stones and even staghorns. In the above manuscript, the authors present
a retrospective series of 351 patients who underwent sPCNL from 2000 to 2010.
2
Although this method was first proposed by Wong and Leveillee,
3
the authors should be commended for their meticulous collection of data over the
10-year period. In addition to limiting the incision to a single site (laparo-endoscopic
single site [LESS), they also used a flexible ureteroscope through a natural orifice
(urethra) during second-look nephroscopy to access calyces inaccessible using a flexible
nephroscope; thus combining LESS with natural orifice transurethral endoscopic surgery
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References
- AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations.J Urol. 2005; 173: 1991-2000
Shahrour K, Tmoaszewski J, Ortiz T, et al. Predictors of immediate post-operative outcome of single-tract percutaneous nephrolithotomy. Urology. 17057.
- Single upper-pole percutaneous access for treatment of ≥ 5-cm complex branched staghorn calculi: is Shock wave lithotripsy necessary?.J Endourol. 2002; 16: 477-481
- Does previous extracorporeal shock wave lithotripsy affect the performance and outcome of percutaneous nephrolithotomy?.J Urol. 2009; 181: 663-667
- Percutaneous nephrolithotomy after failure of extracorporeal shock wave lithotripsy: indications, results, perspectives.Prog Urol. 1993; 3: 951-958
- Percutaneous nephrolithotomy complications in 671 consecutive patients.Urol J. 2011; 8: 271-276
- Percutaneous nephrolithotomy requiring multiple tracts: comparison of morbidity with single-tract procedures.J Endourol. 2006; 20 ((): 753-760
Article info
Publication history
Published online: May 03, 2012
Identification
Copyright
© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.