Perkutane Steintherapie heute: Standard-, Mini-, Micro-, Ultramini-PCNL

Zusammenfassung

Hintergrund: Die perkutane Nephrolitholapaxie (PCNL) stellt heutzutage die wesentliche Behandlung bei großen Nierensteinen (> 2 cm Durchmesser) dar. Mit der Einführung miniaturisierter Techniken wurde die Indikation für die PCNL erweitert: kleinere Steine können ebenfalls mittels PCNL behandelt werden. Für nicht endourologische tätige Urologen ist es mittlerweile schwierig, den Überblick über die Vielzahl verfügbarer Techniken zu behalten. Dieser Artikel stellt im Folgenden die verschiedenen, kommerziell erhältlichen, perkutanen Systeme mit ihren Besonderheiten und Indikationen vor.

Material und Methoden: Eine PubMed-basierte Literaturrecherche wurde durchgeführt. Mithilfe der verfügbaren Herstellerliteratur wurde eine Übersicht über die aktuell verfügbaren PCNL-Systeme erstellt. Desweiteren wurde anhand der Literatur ein Abriss über Indikationen, Steinfreiheits- und Komplikationsraten der PCNL-Systeme verfasst.

Ergebnisse: Es existieren verschiedene Systeme von unterschiedlichen Herstellern mit zum Teil sich überschneidenden Indikationen. Eine Reduktion der Transfusions- und Komplikationsraten durch die Benutzung kleinerer Schaftdurchmesser (Mini- statt Standard-PCNL) wurde in retrospektiven Studien nachgewiesen, in prospektiv-randomisierten Studien bislang jedoch nicht bestätigt. Ob die Miniaturisierung der konventionellen PCNL tatsächlich Vorteile für den Patienten bringt, lässt sich aus der heutigen Studienlage nicht eindeutig beantworten.

Schlussfolgerungen: Durch die heute verfügbaren miniaturisierten PCNL-Instrumente konnte die Invasivität der PCNL gesenkt werden. Die Indikation für die PCNL wurde auf kleinere Nierensteine > 1 cm Durchmesser ausgeweitet.

Abstract

Background: Percutaneous nephrolithotripsy (PCNL) is one of the main interventional treatment modalities for large kidney stones (> 2 cm diameter). With the implementation of miniaturised techniques the indications for PCNL have been broadened to smaller stones. Especially for urologists without emphasis on endourology it is difficult to have an overview of the growing multitude of available systems and techniques. This article describes the currently available systems for percutaneous stone treatment with their peculiarities and indications.

Materials and Methods: A PubMed-based literature search has been conducted. Relevant articles and additional manufacturers’ literature have been compiled to create a summary of the different available PCNL systems. Furthermore, a brief literature review is given regarding indications, stone-free rates and complication rates of each system category.

Results: Several manufacturers have developed different PCNL systems with varying diameters and special features. The indications for the different systems are overlapping. Retrospective studies showed reduced complication rates (especially less bleeding and need for transfusions) but prospective randomised controlled trials on this topic are still lacking. Assessed with the criteria of evidence-based medicine, the currently available evidence does not clearly answer the question whether a miniaturisation of PCNL systems is advantageous for the patient.

Conclusion: Invasiveness of PCNL can be reduced with the nowadays available miniaturised systems. The indication for PCNL has been broadened to small kidney stones > 1 cm diameter.

Schlüsselwörter

Perkutane Nephrolitholapaxie - PCNL - Mini-PCNL - Ultramini-PCNL - Micro-PCNL

Key words

percutaneous nephrolithotripsy - PCNL - miniperc - ultraminiperc - microperc

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