![]() There are a number of different nomenclatures used to describe sizes less than the more traditional 26Fr–28Fr, but thus far there has been no consensus. Miniaturised PCNL is often heralded as having similar benefits to a ‘totally tubeless’ PCNL which had its inception in the treatment of stones in the paediatric population – described in 1997 by Helal et al., using a 10Fr paediatric cystoscope. In tandem with this, the miniaturisation of the PCNL has continued to gain ground over the past 10 years it is now considered a reasonable option for smaller-than-traditional PCNL stone sizes (such as in patients with refractive stent symptoms, who are keen to avoid a two-phased flexible ureterorenoscopy).įurthermore, the range of approaches available to miniaturisation (from 4.8Fr-26Fr), varying opinions on nomenclature and early data make it difficult to ascertain the best approach / size, with proponents putting forward data on the superiority of their chosen technique / size. In many clinical scenarios, the widespread use of flexible ureterorenoscopy with vastly improved optics, irrigation and the advent of the ‘disposable scope’ has made an inevitable encroachment into the PCNL’s territory for tackling larger renal stones. With so much at stake and such variation in practice, it is important to carefully select, work up and approach cases with the method that feels most comfortable to the operating team. It is often the preference and clinical decision-making of the operating surgeon that will define the approach, position, access, technique and drainage postoperatively. Over the past 20 years, improvements in nephroscopes, guidewires, stents and stone fragmentation devices have led to the constant refinement of the technique with an ever-increasing range of stone sizes applicable for its use.ĭespite these advances, PCNL still represents a high-risk operation associated with morbidity and even occasionally mortality. Originally described by Fernstrom and Johansen on three patients in 1976, early pioneers included Alken, Marberger and Wickham in Europe, with Clayman, Smith and Segura across the Atlantic in the USA. Since its development in the 1970s, it has undergone a series of refinements that could only have been possible with the symbiosis of both radiological and urological advancements. Percutaneous nephrolithotomy ( PCNL) is now the gold standard approach to treating large renal stones. ![]()
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