PCNL: cosa è cambiato.

Percutaneous nephrolithotomy (PCNL) is an endourological technique for the treatment of kidney stones. Its goal is their complete clearance via percutaneous access. The technique as we know it today was developed by Johansson and Fernstrom in 1976. They used the technological advances in percutaneous fluoroscopy of the time to obtain percutaneous access. Following the application of various sources of energy (including ultrasound) for the fragmentation of calculi, PCNL gained worldwide acclaim thanks to Alken and Marbergen in Europe and Segura and Clayman in the US. Although in the early 1980s PCNL lost the initial momentum in favor of shock wave lithotripsy, it had a revival in the 1990s as a result of the application of emerging technologies such as computed tomography, new percutaneous access techniques, flexible instrumentation, laser energy and, more recently, robotic surgery and virtual reality. All of these have contributed to steering PCNL towards mini-invasiveness, culminating in the development of microperc. Microperc allows the treatment of calculi as large as 2 cm, obtaining access under ultrasound, fluoroscopy and direct vision guidance. A complete system comprising micro-optics, laser fiber and irrigation is then inserted into a needle with a diameter of 4.85, 8 or 10 Fr . The Clinical Research Office of the Endourological Society (CROES) has made use of the logistic developments to create a global network and a multicenter database. The PCNL study, which was concluded in 2009, has led to the publication of as many as 27 scientific papers on the subject. [ABSTRACT FROM AUTHOR]