The History and Development of Percutaneous Nephrolithotomy

Abstract

The standard treatment for patients with renal calculi prior to the mid 1950s was open stone surgery. The existence of a relatively avascular plane 5 mm posterior to the midline of the kidney was establish through the work of Joseph Hyrtl in 1882 and Max Brödel in 1902. It was not until 1941, that Rupel and Brown would perform the first nephroscopy by placing a rigid cystoscope through a nephrostomy tract so that stones could be removed during open surgery. Willard Goodwin , in 1955, is credited with performing the first nephrostomy tube placement. By 1976 Fernström and Johansson were the first to describe a technique for extracting renal calculi through a percutaneous nephrostomy under radiologic control. In 1978, Arthur Smith would describe the first antegrade stent placement and would coin the term “endourology” to describe closed, controlled manipulation of the genitourinary tract. His collaboratoin with Kurt Amplatz, an interventional radiologist and medical inventor, would lead to numerous innovations which would further advance percutaneous nephrolithotmy (PCNL). Advances in radiology, from improvements in fluoroscopy to the use of pre-operative computed tomography would further aid in renal access. The development of various lithotripsy devices and the introduction of the holmium laser improved the efficacy of stone fragmentation and clearance. Numerous factors contributed to development of the modern day PCNL and this technique will continue to evolve in the future.