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

Zeng G.-H. Zhong W. Mazzon G. Zhu W. Lahme S. Khadgi S. Desai J. Agrawal M. Schulsinger D. Gupta M. Montanari E. Martinez J.M.L. Almousawi S. Malonzo V.E.F. Sriprasad S. Durutovic O. Arumuham V. Ferretti S. Kamal W. Xu K.-W. Cheng F. Gao X.-F. Cheng J.-W. Somani B. Duvdevani M. Git K.A. Seitz C. Bernardo N. Ibrahim T.A.A. Aquino A. Yasui T. Fiori C. Knoll T. Papatsoris A. Gadzhiev N. Zhanbyrbekuly U. Angerri O. Ramos H.L. Saltirov I. Moussa M. Giusti G. Vicentini F. Suarez E.B. Pearle M. Preminger G.M. Wu Q.-H. Ghani K. Maroccolo M. Brehmer M. Osther P.J. Zawadzki M. Tursunkulov A. Kytaibekovich M.N. Abuvohidov A.A. Lara C.A.R. Noori Z. Zanetti S.P. Shrestha S. de la Rosette J. Denstedt J. Ye Z.-Q. Sarica K. Choong S.
December 2024 BioMed Central Ltd

Military Medical Research
2024 #11 Issue 1

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.

Expert consensus , Kidney stone , Miniaturized PCNL (mPCNL) , Operation , Percutaneous nephrolithotomy (PCNL)

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Department of Urology and Guangdong Key Laboratory of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510230, China
Department of Urology, San Bassiano Hospital, Vicenza, 36061, Italy
Department of Urology, Siloah St. Trudpert Hospital, Pforzheim, 75179, Germany
Department of Urology, Vayodha Hospital, Kathmandu, 44600, Nepal
Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, 387001, India
Department of Urology, Centre for Minimally-Invasive Endourology, Global Rainbow Healthcare, Agra, 282007, India
Department of Urology, Stony Brook University School of Medicine, Stony Brook, 11794, NY, United States
Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, 10029, NY, United States
Department of Urology, Fondazione IRCSS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, 20122, Italy
Department of Urology, Barcelona Clinical Hospital, Barcelona, 08036, Spain
Department of Urology, Sabah Al Ahmad Urology Centre, Kuwait, 20005, Kuwait
Department of Surgery, Section of Urology, Veterans Memorial Medical Center, Quezon City, Metro Manila, 1110, Philippines
Department of Urology, Darent Valley Hospital, Dartford, DA2 8DA, United Kingdom
Department of Urology, University of Belgrade, Belgrade, 11120, Serbia
Department of Urology, Stone and Endourology Unit, University College London Hospitals NHS Foundation Trust, London, NW1 2BU, United Kingdom
Department of Urology, Hospital, University of Parma, Parma, 43126, Italy
Department of Urology, King Fahd Hospital, Jeddah, 23325, Saudi Arabia
Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
Department of Urology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
Department of Urology, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
Department of Urology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530022, China
Department of Urology, University Hospital Southampton NHS Trust, Southampton, SO16 6YD, United Kingdom
Department of Urology, Hadassah Hebrew University Hospital, Jerusalem, 91120, Israel
Department of Urology, Pantai Hospital, Penang, 11900, Malaysia
Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, 1090, Austria
Department of Urology, Hospital de Clinicas Jose de San Martin, Buenos Aires, 1120, Argentina
Department of Urology, Hamad Medical Corporation, Doha, 2001, Qatar
Department of Urology, Jose R. Reyes Memorial Medical Center, Manila, 1003, Philippines
Department of Nephrourology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 464-0083, Japan
Department of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, 10043, Italy
Department of Urology, Klinikum Sindelfingen-Boeblingen, University of Tuebingen, Tuebingen, 71032, Germany
Department of Urology, Sismanogleion General Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, 15126, Greece
Department of Urology, Saint-Petersburg State University Hospital, Saint-Petersburg, 194100, Russian Federation
Department of Urology and Andrology, Astana Medical University, Astana, 010000, Kazakhstan
Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, 08025, Spain
Department of Urology, San Ignacio University Hospital, Bogotá, 110231, Colombia
Department of Urology and Nephrology, Military Medical Academy, Sofia, 1431, Bulgaria
Department of Urology, Al Zahraa Hospital University Medical Center and Lebanese University, Beirut, 10001, Lebanon
Department of Urology, IRCCS San Raffaele Hospital, Ville Turro Division, Milan, 20127, Italy
Department of Urology, Endourology and Stone Disease Section, University of Sao Paulo Medical School, Sao Paulo, 05508, Brazil
Department of Urology, Specialty Hospital La Raza, National Medical Center of the Mexican Institute of Social Security, Mexico City, 97217, Mexico
Department of Urology, UT Southwestern Medical Center, Dallas, 75390, TX, United States
Division of Urologic Surgery, Duke University Medical Center, Durham, 27705, NC, United States
Department of Urology, National University Hospital, Singapore, 119074, Singapore
Department of Urology, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, 112106, Serbia
Department of Urology, Division of Endourology, University of Michigan, Ann Arbor, 48109, MI, United States
Department of Urology, Hospital de Base of the Federal District, Brasília, 70330-150, Brazil
Department of Urology, Karolinska University Stockholm Sweden and Aarhus University Hospital, Stockholm, 17176, Denmark
Department of Urology, Lillebaelt Hospital, University of Southern Denmark, Vejle, 246000, Denmark
Department of Urology, St. Anna Hospital, Piaseczno, 05500, Poland
Department of Urology, Akfa Medline Hospital, Tashkent, 100211, Uzbekistan
Department of Urology, DOC University Clinic, Bishkek, 760000, Kyrgyzstan
Department of Urology, Tajik State Medical University, Dushanbe, 734003, Tajikistan
Department of Urology, Tte. Ettiene 215, Fernando de la Mora, 110309, Paraguay
Department of Urology, Aria Apollo Hospital, Ameriat Square, Herat, 3001, Afghanistan
Department of Urology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, 28-20122, Italy
Department of Surgery, Nepal Medical College Teaching Hospital, Jorpati, Kathmandu, 44600, Nepal
Department of Urology, Istanbul Medipol University, Istanbul, 34815, Turkey
Department of Surgery, Division of Urology, Western University, Schulich School of Medicine and Dentistry, London, N6A 5C1, ON, Canada
Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430074, China
Department of Urology, Medical School, Biruni University, Istanbul, 34020, Turkey
Department of Urology, University College Hospital of London, London, NW1 2BU, United Kingdom

Department of Urology and Guangdong Key Laboratory of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Surgery
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Nephrourology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology and Andrology
Department of Urology
Department of Urology
Department of Urology and Nephrology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Division of Urologic Surgery
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Urology
Department of Surgery
Department of Urology
Department of Surgery
Department of Urology
Department of Urology
Department of Urology

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