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

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 rec...

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Autores: Zhong, Wen|||0000-0003-0540-7195, Gupta, M., Seitz, Christian, Bernardo Lambrich, Noemí, Fiori, C., Angerri Feu, Oriol|||0000-0003-3363-6585, Pearle, M., Shrestha, S., Sarica, K., Zeng, Guo-Hua, Mazzon, Giorgio, Zhu, Wei, Lahme, Sven, Khadgi, Sanjay, Desai, Janak, Agrawal, Madhu, Schulsinger, David, Montanari, Emanuele, Martinez, Juan Manuel Lopez, Almousawi, Shabir, Malonzo, Vincent Emanuel F., Sriprasad, Seshadri, Durutović, Otas, Arumuham, Vimoshan, Ferretti, Stefania, Kamal, Wissam, Xu, Ke-Wei, Cheng, Fan, Gao, Xiao-Feng, Cheng, Ji-Wen, Somani, Bhaskar K.|||0000-0002-6248-6478, Duvdevani, Mordechai, Git, Kah Ann, Ibrahim, Tarek Ahmed Amin, Aquino, Albert, Yasui, Takahiro, Knoll, Thomas, Papatsoris, Athanasios, Gadzhiev, Nariman K.|||0000-0002-6255-0193, Zhanbyrbekuly, Ulanbek, Ramos, Hugo Lopez, Saltirov, Iliya, Moussa, Mohamad, Giusti, Guido, Vicentini, Fabio, Suarez, Edgar Beltran, Preminger, Glenn M., Wu, Qing-Hui, Ghani, Khurshid, Maroccolo, Marcus, Brehmer, Marianne, Osther, Palle J., Zawadzki, Marek, Tursunkulov, Azimdjon N.|||0000-0002-1400-178X, Kytaibekovich, Monolov Nurbek, Abuvohidov, Abdusamad Abdukakhorovich, Lara, Cesar Antonio Recalde, Noori, Zamari, Zanetti, Stefano Paolo, de la Rosette, Jean, Denstedt, John, Ye, Zhang-Qun, Choong, Simon
Tipo de recurso: artículo
Fecha de publicación:2024
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:309314
Acceso en línea:https://ddd.uab.cat/record/309314
https://dx.doi.org/urn:doi:10.1186/s40779-024-00562-3
Access Level:acceso abierto
Palabra clave:Expert consensus
Kidney stone
Miniaturized PCNL (mPCNL)
Operation
Percutaneous nephrolithotomy (PCNL)
Descripción
Sumario: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.

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