Table Of ContentMinimally Invasive
Percutaneous
Nephrolithotomy
Madhu S. Agrawal
Dilip K. Mishra
Bhaskar Somani
Editors
Minimally Invasive Percutaneous
Nephrolithotomy
Madhu S. Agrawal • Dilip K. Mishra
Bhaskar Somani
Editors
Minimally Invasive
Percutaneous
Nephrolithotomy
Editors
Madhu S. Agrawal Dilip K. Mishra
Professor and Head, Department Head, Department of Urology
of Urology Pushpanjali Hospital
Global Rainbow Healthcare and Research Center
Agra, Uttar Pradesh, India Agra, Uttar Pradesh, India
Bhaskar Somani
Professor and Consultant
Urological Surgeon
University Hospital Southampton
Hampshire, UK
ISBN 978-981-16-6000-9 ISBN 978-981-16-6001-6 (eBook)
https://doi.org/10.1007/978-981-16-6001-6
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Foreword
With the advent of percutaneous access to the kidney in the 1980s, Kurt
Amplatz developed a dilating system. I believed, at that time, that the tract
size should allow the percutaneous removal of a 10 mm stone, which would
allow us to use strong forceps through the scope to effectively grasp the stone.
Empirically, it was decided that the largest Amplatz sheath would have an
inner circumference of 30 mm.
Industry has now developed effective lithotripters and most fragments can
be easily irrigated following fragmentation and larger fragments can be
grasped with more delicate instruments. This allows sheaths with a smaller
inner circumference to be used effectively.
Any changes in instrumentation and techniques that diminish morbidity in
percutaneous renal surgery are welcome. Some studies have shown decreased
blood loss with smaller tracts while others have shown no difference in the
incidence of blood transfusion. Smaller scopes have a smaller field of vision
and usually the procedures take longer. However, if the morbidity is less, it is
time well spent.
Dr Agrawal and his co-editors are very experienced endourologists and
they have compiled an excellent book covering all aspects of “Mini-PCNL”.
They have selected authorities in the field to write the various chapters and I
highly recommend this book to all endourologists. It not only covers all the
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vi Foreword
basic techniques, but in addition it elucidates the latest technology. It is so
thorough that it will be a text that you will use repeatedly in your career as
you encounter the various problems that we all experience in the treatment of
difficult stones.
Arthur D. Smith, MD
Long Island Jewish Medical Center
New York, USA
Donald and Barbara Zucker School
of Medicine at Hofstra/Northwell
New York, USA
Northwell Health Urology at the Center for Advanced Medicine
New Hyde Park, NY, USA
[email protected]
Foreword
Stone disease is a global disease affecting all people of all ethnicity and gen-
der. There are around 50% chance of recurrent stone formation in a patient
with stone disease. The stone disease may hamper kidney health and may
even lead to renal failure.
Over decades, there has been a paradigm shift from high stone bulk like
staghorn stones to lower stone bulk. There is early detection of smaller stones
due to current imaging modalities. There have been technical advancements
in stone management from open approach to minimally invasive endouro-
logical approach. The endourological management of kidney stone disease
has undergone significant improvements from a large bore approach like
standard PCNL to a very small-bore approach like Microperc. There have
been improvements in the energy source technology as well. There has been
shift in intra-corporeal lithotripsy from low-power laser to high-power laser
and shift from traditional pneumatic to combined ultrasonic and pneumatic
lithotripsy along with integrated suction. Newer ideas are being explored in
stone management like addition of suction to the PCNL sheath. These
advancements have led to miniaturisation of PCNL tract leading to increased
implications of mini-PCNL in all stone scenarios.
This book focussing on mini-PCNL has thrown light on all aspects right
from surgical anatomy of kidney, various patient positions, anaesthesia chal-
lenges, renal imaging and access, lithotripsy modalities, newer advances in
the energy sources, and challenging situations in Mini-PCNL. I would take
this opportunity to congratulate Dr Madhu S. Agrawal and his team for
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viii Foreword
addressing each aspect of mini-PCNL and inviting expert global faculties for
their contributions. It would be an excellent piece of work for residents and
endourologists.
Mahesh Desai, MS, FRCS, FRCS, FACS
Muljibhai Patel Urological Hospital
Nadiad, Gujarat, India
Preface
The treatment of stone disease has undergone dramatic changes with the
introduction of minimally invasive technology. Percutaneous Nephrolithotomy
(PCNL) has become the mainstay of surgical treatment for large volume
nephrolithiasis in the present time. Percutaneous stone surgery has also
evolved from large tracts to smaller tracts over a period of time. This mono-
graph on Mini-PCNL has been prepared to cover all aspects and latest
advances in this exciting field of minimally invasive percutaneous surgery
with an honest overview from the leading world experts.
The book is composed of 30 chapters divided into 8 sections, which help
maintain the flow. Section 1 deals with the history and anatomical principles
of m-PCNL including the ALARA principle of reducing radiation. Section 2
covers the armamentarium for m-PCNL including the fragmentation devices
used with it. Section 3 looks into the anaesthetic considerations and the posi-
tioning of the patient for this procedure. Section 4 covers all aspects of renal
access for the m-PCNL. Section 5 covers the nuances of the procedure includ-
ing tract dilatation, intrarenal pressure, fluid management, and exit strategy.
Section 6 investigates the modern aspects of m-PCNL including the varia-
tions of m-PCNL including the micro, ultra-mini, super-mini, and ECIRS
techniques. Section 7 covers special situations of doing m-PCNL including
bilateral procedures, renal anomalies, renal transplant, obese and paediatric
patients. Section 8, which is the last section, looks into the complications and
outcomes of m-PCNL.
The book covers all aspects of m-PCNL and will be a good guide to new
endourology trainees as well as a refresher and update for experienced endou-
rologists. The use of figures and tables allows the reader to understand and
comprehend the message well. This summarises all aspects of m-PCNL
including the future aspects of technological advances. We hope all urologists
will enjoy reading this, also that this monograph will encourage safe and
standardised uptake of m-PCNL.
We are grateful to all authors for their contribution and support in this
endeavour. We would also like to take this opportunity to thank our families
for their support, our office staff for their help in preparation of the manu-
script, and the publishers Springer Nature and their team for their help and
cooperation in making this project successful.
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x Preface
Editors
Agra, India Madhu S. Agrawal
Hampshire, UK Bhaskar Somani
Agra, India Dilip K. Mishra
