Department of Urology, University of Michigan, Ann Arbor, MI, USA.
Department of Urology, McGill University, Montreal, Canada.
Eur Urol. 2016 Aug;70(2):382-96. doi: 10.1016/j.eururo.2016.01.047. Epub 2016 Feb 11.
Percutaneous nephrolithotomy (PCNL) is the surgical standard for treating large or complex renal stones. Since its inception, the technique of PCNL has undergone many modifications.
To perform a collaborative review on the latest evidence related to outcomes and innovations in the practice of PCNL since 2000.
A literature review was performed using the PubMed database between 2000 and July 2015, restricted to human species, adults, and the English language. The Medline search used a strategy including the following keywords: percutaneous nephrolithotomy, PNL, advances, trends, technique, and the Medical Subject Headings term percutaneous nephrostomy.
Population-based studies have now provided a wealth of information regarding patient outcomes following PCNL. The complexity of the stone treated can be quantified using a variety of validated nephrolithometry classification systems. Increasing familiarity with the supine approach to PCNL has enabled simultaneous combined retrograde and antegrade surgery. Advances such as endoscopic guided percutaneous access may help urologists achieve access with less morbidity. Increasing miniaturization of equipment has led to the development of mini, micro, and ultramini techniques. The tubeless method of PCNL is now accepted practice with good evidence of safety in appropriately selected patients.
Modern-day PCNL allows personalized stone management tailored to individual patient and surgeon factors. Future studies should continue to refine methods to assess complexity and safety and to determine consensus on the use of miniaturized PCNL.
Modern-day percutaneous nephrolithotomy has transformed from an operation traditionally undertaken in one position, using one access method with one set of instrumentation and one surgeon, to one with a variety of options at each step.
经皮肾镜碎石术（PCNL）是治疗大或复杂肾结石的手术标准。自诞生以来，PCNL 技术经历了许多改进。
对 2000 年以来 PCNL 实践中与结局和创新相关的最新证据进行协作回顾。
在 2000 年至 2015 年 7 月期间，我们使用 PubMed 数据库进行了文献回顾，限制为人类、成年人和英语。Medline 搜索使用了一种策略，包括以下关键词：经皮肾镜碎石术、PNL、进展、趋势、技术和医学主题词经皮肾造口术。
基于人群的研究现在提供了大量关于 PCNL 后患者结局的信息。所治疗结石的复杂性可以使用多种经过验证的肾结石计量分类系统进行量化。对 PCNL 仰卧位方法的日益熟悉使同时进行逆行和顺行手术成为可能。诸如内窥镜引导的经皮进入等进展可能有助于泌尿科医生以较低的发病率获得进入途径。设备的不断小型化导致了迷你、微和超迷你技术的发展。PCNL 的无管方法现在是一种公认的实践，在适当选择的患者中有良好的安全性证据。
现代 PCNL 允许根据患者和外科医生的个体因素进行个体化的结石管理。未来的研究应继续改进评估复杂性和安全性的方法，并就微创 PCNL 的使用达成共识。
现代经皮肾镜碎石术已经从传统的单一手术体位、单一入路方法、单一器械和单一外科医生转变为在每个步骤都有多种选择的手术。
