Percutaneous nephrolithotomy in the treatment of urolithiasis

Abstract

Introduction: Percutaneous nephrolithotomy (PCNL) was proposed by W. E. Goodwin in 1955. This year, Goodwin made the first percutaneous pielostomie in hydronephrosis, and subsequently to propose this method for the surgical treatment of minimally invasive kidney stones. The first intervention was performed by Fernstrom and Johansson in 1975, extracting a kidney stone using an endoscope. Due to technical progress and improving technique, it was possible to improvement and reduce complications method with a success rate of about 98-99%.

Objective: Analysis of contemporary method of treatment of kidney stones by percutaneous nephrolithotomy, indications, contraindications and benefits of this method compared to open surgery, lithotripsy extracorporeal shock wave under reference study. Reviewing progress specialized surgical techniques and instrumentation that continues to improve PCNL as contemporary method of treatment of urolithiasis.

Material and methods: Percutaneous nephrolithotomy (PCNL) is a miniinvasive method of treatment of nephrolithiasis and/or ureteral lithiasis. The method consists of pointing an inferior or medium calyx, with further dilatation and creation of a path for lithotripsy and extraction of stone via the percutaneous path. In this study are analyzed the indications, contraindications, advantages and different authors opinion on NLP in lithiasic kidney surgery. The “stone free” rate is comparable with the successes of open surgery. Nowadays this is one of the elective methods in treatment of nephrolithiasis and/or ureteral lithiasis.

Conclusions: Minimally invasive percutaneous approaches offer the benefits of reduced blood loss, rate decrease residual fragments and a return to normal activity of the patient faster. Regarding the rate of "stone free" in the literature showing a rate of about 85% with a 30% recurrence for proper stones larger than 2 cm. PCNL is an effective method of treatment of stones renoureterale. The advantages of the method are minimal trauma, decrease morbidity and length of hospital stay, postoperative complications rate decrease. Improving methods of intraoperative lithotripsy (ultrasound, laser, hydraulic) make PCNL be a method of choice in the treatment of kidney stones.