title: [Clinical value of percutaneous nephrolithotomy].
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.
authors.affiliation: Urologische Universitätsklinik Mannheim, Mannheim. t.knoll@uro.ma.uni-heidelberg.de
authors.forename: T
authors.initials: T
authors.lastname: Knoll
authors.forename: G
authors.initials: G
authors.lastname: Wendt-Nordahl
authors.forename: P
authors.initials: P
authors.lastname: Alken
mesh_terms: D004867:Equipment Design; D006801:Humans; D007669:Kidney Calculi / Q000000981:diagnostic imaging / Q000628:therapy*; D007670:Kidney Calices / Q000000981:diagnostic imaging; D008096:Lithotripsy / Q000009:adverse effects; D009403:Nephrostomy, Percutaneous / Q000009:adverse effects / Q000295:instrumentation; D017063:Outcome Assessment, Health Care; D011677:Punctures / Q000295:instrumentation; D016896:Treatment Outcome; D014463:Ultrasonography
references.citation: Eur Urol. 2001 Oct;40(4):362-71
references.pmid: 11713390
references.citation: AJR Am J Roentgenol. 1987 Jan;148(1):177-80
references.pmid: 3491509
references.citation: J Urol. 1985 Dec;134(6):1077-81
references.pmid: 4057395
references.citation: Eur Urol. 2001 Dec;40(6):619-24
references.pmid: 11805407
references.citation: Eur Urol. 2001 Nov;40(5):589-99
references.pmid: 11752871
references.citation: J Urol. 2004 Aug;172(2):565-7
references.pmid: 15247731
references.citation: Eur Urol. 2005 Jan;47(1):22-8
references.pmid: 15582245
references.citation: Urology. 2001 Sep;58(3):345-50
references.pmid: 11549477
references.citation: J Urol. 2001 Dec;166(6):2072-80
references.pmid: 11696709
references.citation: J Urol. 1998 Sep;160(3 Pt 1):669-73
references.pmid: 9720518
references.citation: J Endourol. 2002 Jun;16(5):281-8
references.pmid: 12184077
references.citation: Curr Opin Urol. 2003 May;13(3):235-41
references.pmid: 12692448
references.citation: J Urol. 1981 Apr;125(4):463-6
references.pmid: 7218439
references.citation: Eur Urol. 2000 Feb;37(2):136-9
references.pmid: 10705189