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Miniaturization of percutaneous nephrolithotomy Smaller, but better?

Huusmann, Stephan; Nagele, Udo; Herrmann, Thomas R.W.on behalf Training and Research in Urological Surgery and Technology (T.R.U.S.T.)-Group

doi: 10.1097/MOU.0000000000000375
EMERGING TECHNOLOGIES IN UROLOGIC SURGERY: Edited by Jean J.M.C.H. de la Rosette and Jim C. Hu

Purpose of review Miniaturized percutaneous nephrolithotomy (PCNL) procedures have reached big popularity in the past years. Following the idea that decreasing the diameter of the instruments would decrease the complication rate instruments with outer diameter down to 4,8 Fr was established. In this review, we want to take a critical insight of the most popular miniaturized procedures, regarding the key advantages and disadvantages of the miniaturized instruments.

Recent findings For all techniques displayed, a number of studies are available to support their effectivity in the given range of indication. Naturally, the body of evidence for M-sized instruments is largest, as it exists in the armamentarium since long, whereas studies comparing small or extrasmall and extraextrasmall to standard or among each other are rare. However, large studies comparing miniaturized procedures with conventional PCNL in randomized controlled fashion are still lacking, too.

Summary Miniaturization and attending developments such as ultrasonographic-guided puncture, single step dilatation of the tract, low irrigation pressure in open systems and a tubeless procedure lead to lower complication rates in PCNL. All of the established procedures have their own range of indication with regard to size and location of the stone. They amplified the possibility of a customized therapy for each patient.

aDivision of Endoscopy and Laparoscopy, Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany

bDepartment of Urology and Andrology, Tirol Hospitals, Hall in Tirol, Austria

Correspondence to Thomas R.W. Herrmann, MD, Division of Endoscopy and Laparoscopy, Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Tel: +49 511 532 6673; e-mail:

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