[Clinical value of percutaneous nephrolithotomy]. / Perkutane Nephrolithotomie Indikationen, Durchführung und heutiger Stellenwert.

ABSTRACT

The introduction of percutaneous nephrolithotomy (PNL) marked a turning point in the interventional treatment of nephrolithiasis. For the first time, the minimally invasive removal of larger kidney stones, which had previously required open surgery, became possible. With the increasing use of extracorporeal shock wave lithotripsy (SWL) during the 1980s, PNL lost clinical importance. However, since SWL has revealed its limitations, and both the patients' wishes and economic demand require a fast stone removal, the importance of PNL has risen again. Given the correct indications and performance, PNL is an efficient treatment modality reaching stone free rates of up to 100%. When PNL is performed by an experienced urologist, complications are low and can be managed conservatively in most cases. The most important step in the performance of a PNL is the anatomically correct puncture of the kidney gaining optimal access to the stone. To reach this, a lower calyx is punctured whenever possible, under combined sonographic and fluoroscopic guidance.