International Alliance of Urolithiasis (IAU) consensus on miniaturized percutaneous nephrolithotomy.

IF 16.7 2区 医学 Q1 MEDICINE, GENERAL & INTERNAL Military Medical Research Pub Date : 2024-10-28 DOI:10.1186/s40779-024-00562-3
Guo-Hua Zeng, Wen Zhong, Giorgio Mazzon, Wei Zhu, Sven Lahme, Sanjay Khadgi, Janak Desai, Madhu Agrawal, David Schulsinger, Mantu Gupta, Emanuele Montanari, Juan Manuel Lopez Martinez, Shabir Almousawi, Vincent Emanuel F Malonzo, Seshadri Sriprasad, Otas Durutovic, Vimoshan Arumuham, Stefania Ferretti, Wissam Kamal, Ke-Wei Xu, Fan Cheng, Xiao-Feng Gao, Ji-Wen Cheng, Bhaskar Somani, Mordechai Duvdevani, Kah Ann Git, Christian Seitz, Norberto Bernardo, Tarek Ahmed Amin Ibrahim, Albert Aquino, Takahiro Yasui, Cristian Fiori, Thomas Knoll, Athanasios Papatsoris, Nariman Gadzhiev, Ulanbek Zhanbyrbekuly, Oriol Angerri, Hugo Lopez Ramos, Iliya Saltirov, Mohamad Moussa, Guido Giusti, Fabio Vicentini, Edgar Beltran Suarez, Margaret Pearle, Glenn M Preminger, Qing-Hui Wu, Otas Durutovic, Khurshid Ghani, Marcus Maroccolo, Marianne Brehmer, Palle J Osther, Marek Zawadzki, Azimdjon Tursunkulov, Monolov Nurbek Kytaibekovich, Abdusamad Abdukakhorovich Abuvohidov, Cesar Antonio Recalde Lara, Zamari Noori, Stefano Paolo Zanetti, Sunil Shrestha, Jean de la Rosette, John Denstedt, Zhang-Qun Ye, Kemal Sarica, Simon Choong
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Abstract

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts' experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes.

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国际泌尿系结石联盟(IAU)关于微型经皮肾镜取石术的共识。
在过去的三十年里,人们越来越关注以小通道为特点的微型经皮肾镜碎石术(mPCNL)技术,因为这些技术为减轻与标准 PCNL(sPCNL)相关的并发症提供了潜在的解决方案。然而,尽管人们越来越接受并认识到它的好处,但由于对最佳围手术期管理策略和手术技巧缺乏共识,尚未解决的争议和公认的局限性仍阻碍着它的广泛应用。为了应对这些挑战,一个由国际泌尿系结石联盟(IAU)专家组成的国际小组承担了编纂一份有关 mPCNL 手术的专家共识文件的任务,旨在为泌尿科医生提供一个全面的临床实践框架。这项工作包括进行系统的文献综述以确定研究差距 (RG),这为制定结构化问卷调查奠定了基础。随后,进行了两轮修改后的德尔菲调查,最后召开小组会议,提出以证据为基础的最终意见。所有 64 位专家都完成了第二轮调查,回复率为 100.0%。调查共提出了 58 个关键问题,这些问题主要涉及 mPCNL 的 4 个主要领域,包括一般信息(13 个问题)、术前检查(13 个问题)、手术技巧和窍门(19 个问题)以及术后评估和随访(13 个问题)。此外,还有 9 个问题评估了专家们在 PCNL 方面的经验。mPCNL 的特点是结石道小于 18 Fr,并采用了创新的碎石技术,现已成为治疗成人和儿童上尿路结石的一种可行而有效的方法。与 sPCNL 相比,该方法具有多项优势,包括减少出血、减少对肾造瘘管的需求、减轻疼痛和缩短住院时间。本文介绍的一系列详细技术可作为泌尿科医生的综合指南,旨在提高他们对手术的理解,优化患者的治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Military Medical Research
Military Medical Research Medicine-General Medicine
CiteScore
38.40
自引率
2.80%
发文量
485
审稿时长
8 weeks
期刊介绍: Military Medical Research is an open-access, peer-reviewed journal that aims to share the most up-to-date evidence and innovative discoveries in a wide range of fields, including basic and clinical sciences, translational research, precision medicine, emerging interdisciplinary subjects, and advanced technologies. Our primary focus is on modern military medicine; however, we also encourage submissions from other related areas. This includes, but is not limited to, basic medical research with the potential for translation into practice, as well as clinical research that could impact medical care both in times of warfare and during peacetime military operations.
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