Supine percutaneous nephrolithotomy and ECIRS : the new way of interpreting PNL

PNL is the gold standard for the management of large and/or otherwise complex renal stones. Since its introduction in the seventies PNL has undergone considerable evolution, mainly driven by the improvement in access techniques, endoscopic instrument technology, lithotripsy devices and drainage management. The conventional prone position for PNL has been challenged in the last two decades by a variety of modifications, including the supine and Galdakao-modified supine Valdivia positions, which make simultaneous retrograde working access to the collecting system possible and have proven anesthesiological advantages. The Galdakao-modified supine Valdivia position allowed the development of ECIRS (Endoscopic Combined IntraRenal Surgery), a technique exploiting a combined antegrade and retrograde approach to the upper urinary tract, using both rigid and flexible endoscopes with the related accessories. The synergistic teamwork of ECIRS provides a safe and efficient, minimally-invasive procedure for the treatment of all kinds of urolithiasis. The aim of this book is to share with the urologic community worldwide our experience, our standardization of all the steps, and tips and tricks for the procedure. Front Matter....Pages i-xiii Introduction....Pages 1-3 The Early History of Percutaneous Nephrolithotomy (PNL)....Pages 5-14 The Evolution from Prone to Supine PNL and from Supine PNL to ECIRS: The Basque History of Endourology....Pages 15-23 PNL: Indications and Guidelines: Urolithiasis....Pages 25-31 PNL: Indications and Guidelines: Stenosis and Tumours....Pages 33-40 Anatomy for PNL....Pages 41-55 Imaging in Percutaneous Nephrolithotomy....Pages 57-78 Anaesthesia for Supine and Modified Supine PNL....Pages 79-88 Prone PNL: Is It Still the Gold Standard? Review and Results....Pages 89-97 Endoscopic Combined IntraRenal Surgery (ECIRS): Rationale....Pages 99-108 ECIRS: Patient Positioning and Organization of the Operating Room....Pages 109-125 Instruments and Accessories for ECIRS....Pages 127-160 ECIRS: Access Creation....Pages 161-188 Stone Fragmentation and Extraction....Pages 189-198 Kidney Drainage and Percutaneous Tract Closure....Pages 199-208 Supine and Supine Modified PNL in Special Situations....Pages 209-221 PNL in Paediatric Patients....Pages 223-232 Technical Aspects of Percutaneous Management of Ureteral Stenosis and Upper Urinary Tract Transitional Cell Carcinomas (UUT-TCC)....Pages 233-247 The Scrub Nurse’s Point of View on ECIRS (Endoscopic Combined IntraRenal Surgery)....Pages 249-264 Intraoperative Complications: How to Avoid Them?....Pages 265-277 Antibiotic Prophylaxis and Infectious Complications in PNL....Pages 279-292 Prone Versus Supine PNL: Results and Published Series....Pages 293-301 Micro-ECIRS: A Revolutionary New Tool in the Current Endourologic Armamentarium....Pages 303-310 Conclusions and Future Perspectives of PNL....Pages 311-312