International Alliance of Urolithiasis (IAU) consensus on miniaturized percutaneous nephrolithotomy

Zeng GH 1 , Zhong W 2 , Mazzon G 3 , Zhu W 2 , Lahme S 4 , Khadgi S 5 Show all authors , Desai J 6 , Agrawal M 7 , Schulsinger D 8 , Gupta M 9 , Montanari E 10 , Martinez JML 11 , Almousawi S 12 , Malonzo VEF 13 , Sriprasad S 14 , Durutovic O 15 , Arumuham V 16 , Ferretti S 17 , Kamal W 18 , Xu KW 19 , Cheng F 20 , Gao XF 21 , Cheng JW 22 , Somani B 23 , Duvdevani M 24 , Git KA 25 , Seitz C 26 , Bernardo N 27 , Ibrahim TAA 28 , Aquino A 29 , Yasui T 30 , Fiori C 31 , Knoll T 32 , Papatsoris A 33 , Gadzhiev N 34 , Zhanbyrbekuly U 35 , Angerri O 36 , Ramos HL 37 , Saltirov I 38 , Moussa M 39 , Giusti G 40 , Vicentini F 41 , Suarez EB 42 , Pearle M 43 , Preminger GM 44 , Wu QH 45 , Durutovic O 46 , Ghani K 47 , Maroccolo M 48 , Brehmer M 49 , Osther PJ 50 , Zawadzki M 51 , Tursunkulov A 52 , Kytaibekovich MN 53 , Abuvohidov AA 54 , Lara CAR 55 , Noori Z 56 , Zanetti SP 57 , Shrestha S 58 , de la Rosette J 59 , Denstedt J 60 , Ye ZQ 61 , Sarica K 62 , Choong S 63

Affiliations 

  • 1 Department of Urology and Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China. gzgyzgh@vip.sina.com
  • 2 Department of Urology and Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China
  • 3 Department of Urology, San Bassiano Hospital, 36061, Vicenza, Italy
  • 4 Department of Urology, Siloah St. Trudpert Hospital, 75179, Pforzheim, Germany
  • 5 Department of Urology, Vayodha Hospital, Kathmandu, 44600, Nepal
  • 6 Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, 387001, India
  • 7 Department of Urology, Centre for Minimally-Invasive Endourology, Global Rainbow Healthcare, Agra, 282007, India
  • 8 Department of Urology, Stony Brook University School of Medicine, Stony Brook, NY, 11794, USA
  • 9 Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, NY, 10029, USA
  • 10 Department of Urology, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, 20122, Milan, Italy
  • 11 Department of Urology, Barcelona Clinical Hospital, 08036, Barcelona, Spain
  • 12 Department of Urology, Sabah Al Ahmad Urology Centre, 20005, Kuwait, Kuwait
  • 13 Department of Surgery, Section of Urology, Veterans Memorial Medical Center, 1110, Quezon City, Metro Manila, Philippines
  • 14 Department of Urology, Darent Valley Hospital, Dartford, DA2 8DA, UK
  • 15 Department of Urology, University of Belgrade, 11120, Belgrade, Serbia
  • 16 Department of Urology, Stone and Endourology Unit, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, UK
  • 17 Department of Urology, Hospital, University of Parma, 43126, Parma, Italy
  • 18 Department of Urology, King Fahd Hospital, 23325, Jeddah, Saudi Arabia
  • 19 Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
  • 20 Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
  • 21 Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
  • 22 Department of Urology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530022, China
  • 23 Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, UK
  • 24 Department of Urology, Hadassah Hebrew University Hospital, 91120, Jerusalem, Israel
  • 25 Department of Urology, Pantai Hospital, 11900, Penang, Malaysia
  • 26 Department of Urology, Vienna General Hospital, Medical University of Vienna, 1090, Vienna, Austria
  • 27 Department of Urology, Hospital de Clinicas Jose de San Martin, 1120, Buenos Aires, Argentina
  • 28 Department of Urology, Hamad Medical Corporation, 2001, Doha, Qatar
  • 29 Department of Urology, Jose R. Reyes Memorial Medical Center, 1003, Manila, Philippines
  • 30 Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 464-0083, Japan
  • 31 Department of Urology, University of Turin, San Luigi Gonzaga Hospital, 10043, Orbassano, Turin, Italy
  • 32 Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tuebingen, 71032, Tuebingen, Germany
  • 33 Department of Urology, Sismanogleion General Hospital, School of Medicine, National and Kapodistrian University of Athens, 15126, Athens, Greece
  • 34 Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, Russia, 194100
  • 35 Department of Urology and Andrology, Astana Medical University, 010000, Astana, Kazakhstan
  • 36 Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, 08025, Barcelona, Spain
  • 37 Department of Urology, San Ignacio University Hospital, 110231, Bogotá, Colombia
  • 38 Department of Urology and Nephrology, Military Medical Academy, 1431, Sofia, Bulgaria
  • 39 Department of Urology, Al Zahraa Hospital University Medical Center and Lebanese University, Beirut, 10001, Lebanon
  • 40 Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, 20127, Milan, Italy
  • 41 Department of Urology, Endourology and Stone Disease Section, University of Sao Paulo Medical School, Sao Paulo, 05508, Brazil
  • 42 Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, 97217, Mexico City, Mexico
  • 43 Department of Urology, UT Southwestern Medical Center, Dallas, TX, 75390, USA
  • 44 Division of Urologic Surgery, Duke University Medical Center, Durham, NC, 27705, USA
  • 45 Department of Urology, National University Hospital, Singapore, 119074, Singapore
  • 46 Department of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, 112106, Belgrade, Serbia
  • 47 Department of Urology, Division of Endourology, University of Michigan, Ann Arbor, MI, 48109, USA
  • 48 Department of Urology, Hospital de Base of the Federal District, Brasília, 70330-150, Brazil
  • 49 Department of Urology, Karolinska University Stockholm Sweden and Aarhus University Hospital, 17176, Stockholm, Denmark
  • 50 Department of Urology, Lillebaelt Hospital, University of Southern Denmark, 246000, Vejle, Denmark
  • 51 Department of Urology, St. Anna Hospital, 05500, Piaseczno, Poland
  • 52 Department of Urology, Akfa Medline Hospital, 100211, Tashkent, Uzbekistan
  • 53 Department of Urology, DOC University Clinic, 760000, Bishkek, Kyrgyzstan
  • 54 Department of Urology, Tajik State Medical University, 734003, Dushanbe, Tajikistan
  • 55 Department of Urology, Tte. Ettiene 215, 110309, Fernando de la Mora, Paraguay
  • 56 Department of Urology, Aria Apollo Hospital, Ameriat Square, 3001, Herat, Afghanistan
  • 57 Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, 28-20122, Milan, Italy
  • 58 Department of Surgery, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, 44600, Nepal
  • 59 Department of Urology, Istanbul Medipol University, Istanbul, 34815, Turkey
  • 60 Department of Surgery, Division of Urology, Western University, Schulich School of Medicine and Dentistry, London, ON, N6A 5C1, Canada
  • 61 Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430074, China
  • 62 Department of Urology, Medical School, Biruni University, Istanbul, 34020, Turkey
  • 63 Department of Urology, University College Hospital of London, London, NW1 2BU, UK. schoong@aol.com
Mil Med Res, 2024 Oct 28;11(1):70.
PMID: 39465407 DOI: 10.1186/s40779-024-00562-3

Abstract

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts' experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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