Percutaneous laser nephrolithotripsy: is it here to stay? Results of a systematic review

Abstract

Purpose of review PCNL (percutaneous nephrolithotomy) and its miniaturized variants are being widely employed in stone surgery, owing to their high-stone-free rates (SFRs) and efficacy for large (>20 mm) stones. With advances in laser technology, it has been readily utilized in PCNL, with the potential for lower complication rates at similar SFR. We aimed to perform a systematic literature review with a focus on recent prospective clinical data that compares laser PCNL to either nonlaser PCNL, different PCNL sizes or other current standards of care such as shockwave lithotripsy (ESWL) or flexible ureteroscopy (FURS). Recent findingsOf the 294 studies initially identified through database searching, nine papers published between 2019 and 2021 were included which compared laser PCNL (Standard PCNL in three, mini-PCNL in four, ultramini PCNL in one, micro-PCNL in one study) to other nonlaser lithotripsy, ESWL, FURS, and different PCNL sizes. Complications for laser PCNL ranged from bleeding (4.4%), perirenal haematoma (1.1%), fever (4.6%), ureteric/renal pelvic injury (2.3%), haematuria (2.7%), and infection (2.6%). The mean SFR for laser PCNL was 91.5% at 3 months.

Risk factor analysis for infection and bleeding after lateral decubitus percutaneous nephrolithotomy

“…Despite the favorable outcomes of PCNL in treating kidney and upper ureteral stones, there are still potential risks of postoperative complications. [20–23]…”

“…Despite the favorable outcomes of PCNL in treating kidney and upper ureteral stones, there are still potential risks of postoperative complications. [20][21][22][23] Although the incidence of complications related to PCNL has decreased significantly due to improvements in surgical techniques and pre-and perioperative monitoring, the occurrence rates still range from 3% to 83% for various complications. [14,17,24,25] Postoperative infection and bleeding are the most common complications.…”

A meta-analysis: retrograde intrarenal surgery vs. percutaneous nephrolithotomy in children

“…High pressure favors the occurrence of urinary tract infections, which in turn causes fever. What is more, compared with RIRS, mini-PCNL has been bound up with more significant complications such as postoperative bleeding and organic injury, due to its invasive skin puncture ( 32 ). Additionally, it is also possible that fluoroscopy-guided renal access increases the radiation exposure time and higher risk of iatrogenic visceral injury, thus making complications more lethal, supposing a larger size PCNL is conducted ( 32 ).…”

Evolving Role of Lasers in Endourology: Past, Present and Future of Lasers

“…With the advent of laser technology and the increased ability to produce smaller residual fragments or dust, PCNL underwent a process of miniaturization, that was coupled to a decrease in bleeding, leading to higher chance of tubeless procedures and reduced hospital stay [28][29][30]. According to their size, miniaturized techniques are defined as mini-PCNL (16-20 Fr), ultramini-PCNL (UMP, 11-14 Fr), and micro-PCNL (microPNL, <10 Fr) [31].…”