Small-caliber percutaneous nephrolithotomy (SC-PCNL). Therapeutic decision algorithm

Abstract

IntroductionThe progressive reduction in the caliber of the tract in percutaneous kidney surgery to the point of miniaturization has expanded its use to smaller stones that until now have been treated with extracorporeal shock wave lithotripsy (ESWL) and retrograde intrarenal surgery (RIRS). ObjectiveTo provide an update on the various techniques of small-caliber nephrolithotomy (SC-PCNL) analyze their efficacy, safety and indications and determine their degree of implantation at this time. Material and methodsWe performed a review in PubMed of Spanish and English medical literature on the various techniques of SC-PCNL. ResultsThe use of SC-PCNL has reduced the morbidity associated with standard PCNL, particularly bleeding, and has enabled tubeless nephrolithotomy with greater safety. There are various techniques with blurred terminology (Miniperc, Microperc, Mini-microperc, Ultraminiperc), which differ in terms of gauge employed and in certain technical aspects that require their indications be specified. Currently, SC-PCNL competes with techniques that are less invasive than standard PCNL such as ESWL and the RIRS in treating small stones, but the role of SC-PCNL is still not sufficiently understood and continues to be the subject of debate. ConclusionsThe indications for PCNL are expanding to small stone sizes due to the miniaturization of the technique. PCNL competes in this field with ESWL and RIRS. Larder studies are needed to establish the specific indications for PCNL in treating nephrolithiasis.