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 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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Publication Details

Journal
Military Medical Research
Published
2024-10-28
DOI
https://doi.org/10.1186/s40779-024-00562-3
Citations
16
Primary Topic
Kidney Stones and Urolithiasis Treatments
Type
article
Field-Weighted Citation Impact
6.70

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article

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

Christian Seitz, Oriol Angerri, Vimoshan Arumuham, Sanjay Khadgi et al.
16 citations
Military Medical Research
Kidney Stones and Urolithiasis Treatments
6.70
article

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

Christian Seitz, Oriol Angerri, Vimoshan Arumuham, Sanjay Khadgi, Edgar Beltrán Suárez, Wissam Kamal, Albert Aquino, E. Montanari, Chu Ann Chai, Mordechai Duvdevani, Bhaskar Kumar Somani, John D. Denstedt, Qinghui Wu, Stefania Ferretti, Sunil Shrestha, Janak Desai, Marek Zawadzki, Shabir Almousawi, Fabio Carvalho Vicentini, Marianne Brehmer, Palle Jørn Sloth Osther, Thomas Knoll, Simon Choong, Marcus Vinícius Osorio Maroccolo, Mohamad Moussa, Athanasios Papatsoris, Cristian Fiori, Azimdjon Tursunkulov, Glenn M. Preminger, Margaret S. Pearle, Khurshid R. Ghani, Iliya Saltirov, Hugo López‐Ramos, Takahiro Yasui, Guido Giusti, Mantu Gupta, David A. Schulsinger, S.P. Zanetti, Jean de la Rosette, Giorgio Mazzon, Seshadri Sriprasad, Madhu Agrawal, Nariman K. Gadzhiev, Xiaofeng Gao, Kewei Xu, Jiwen Cheng, Guohua Zeng, Wei Zhu, J. Martı́nez, Sven Lahme, Kemal Sarıca, Wen Zhong, Tarek Ibrahim, Norberto Bernardo, C. Lara, Kah Ann, Otaš Durutović, Fan Cheng, Ulanbek Zhanbyrbekuly, Vincent Emanuel F. Malonzo, Monolov Nurbek Kytaibekovich, Abdusamad Abdukakhorovich Abuvohidov, Zamari Noori, Zhangqun Ye
article en
16 citations

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.

Military Medical ResearchVol. 11(1)
Universitat Autònoma de Barcelona (ES), University of Parma (IT), Western University (CA), University College Hospital (GB), Mount Sinai Health System (US), University College London Hospitals NHS Foundation Trust (GB), Nepal Medical College Teaching Hospital (NP), Vita-Salute San Raffaele University (IT), Sun Yat-sen University (CN), Lebanese University (LB), Mexican Social Security Institute (MX), St Petersburg University (RU), Second Military Medical University (CN), University of Southern Denmark (DK), Universidade de São Paulo (BR), University of Milan (IT), Hebrew University of Jerusalem (IL), National and Kapodistrian University of Athens (GR), University of Michigan (US), Tajik State Medical University (TJ), Muljibhai Patel Urological Hospital (IN), Hospital de Base (BR), Sismanoglio General Hospital (GR), Vienna General Hospital (AT), Aarhus University Hospital (DK), University Hospital Southampton NHS Foundation Trust (GB), Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT), Istanbul Medipol University (TR), Nagoya City University (JP), Wuhan University (CN), University of Belgrade (RS), Darent Valley Hospital (GB), Southwestern Medical Center (US), Central Asian University (UZ), Sun Yat-sen Memorial Hospital (CN), First Affiliated Hospital of Guangzhou Medical University (CN), Biruni University (TR), José R. Reyes Memorial Medical Center (PH), Military Medical Academy (BG), Hospital Clínic de Barcelona (ES), Changhai Hospital (CN), Hospital de Clínicas "José de San Martín" (AR), Ospedale San Bassiano (IT), Duke Medical Center (US), Al-Sabah Hospital (KW), Klinikum Sindelfingen-Böblingen (DE), Renmin Hospital of Wuhan University (CN), Astana Medical University (KZ), Lillebaelt Hospital (DK), Puigvert Foundation (ES), National University Hospital (SG), King Fahad Hospital Jeddah (SA), Duke University Hospital (US), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Hospital Universitario San Ignacio (CO), Siloah St. Trudpert Klinikum (DE), Tumor Hospital of Guangxi Medical University (CN), Ospedale San Luigi Gonzaga (IT), St. Anna Hospital (DE), Tongji Hospital (CN), Istituto di Ricovero e Cura a Carattere Scientifico San Raffaele (IT), Southwestern Medical Center (US), University College London (GB), Huazhong University of Science and Technology (CN), Hamad Medical Corporation (QA), University of Turin (IT), Stony Brook University (US), Medical University of Vienna (AT), The University of Texas Southwestern Medical Center (US), Guangzhou Medical University (CN), Icahn School of Medicine at Mount Sinai (US)
Università degli Studi di Milano, İstanbul Medipol Üniversitesi, Huazhong University of Science and Technology, Tongji University, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Schulich School of Medicine and Dentistry, Tongji Medical College, Huazhong University of Science and Technology
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Kidney Stones and Urolithiasis Treatments
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