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Stone Treatment

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Urologic Surgery in the Digital Era

Abstract

Urolithiasis is a common urologic problem with rising prevalence and incidence around the world, constituting a significant burden on health care systems.

Percutaneous nephrolithotomy (PCNL) is the gold standard for treating large kidney stones (≥2 cm). The percutaneous puncture of a renal calyx is a key step in this procedure and many techniques have been investigated in order to improve its safety and success.

Miniaturized PCNL was introduced to reduce access-related complications and morbidity but the results were not very different from standard PCNL.

Alternative puncture approaches, such as the incorporated optical system, the Uro-Dyna-CT, the SonixGPS and the electromagnetic navigation systems have been developed to facilitate puncture. From these, the SonixGPS and the electromagnetic navigation system are the most promising and clinically applicable techniques, as they allow adjustment of the needle path in real time, provide fast procedures and learning curves and avoid fluoroscopy use.

Renal drainage after PCNL is also a matter of debate. Multiple studies have shown that in selected cases outcomes are similar if patients are managed with a ureteral stent and no nephrostomy tube (tubeless) or even without a stent or nephrostomy tube (totally tubeless). Biodegradable ureteral stents may be an option to overcome stent-related complications and the need for stent removal.

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Author information

Authors and Affiliations

  1. Urology Unit, Policlinico Tor Vergata Foundation, Rome, Italy

    Luca Orecchia & Stefano Germani

  2. Urology Department, Hospital de Braga, Braga, Portugal

    Sara Anacleto

  3. Department of Surgical Sciences, University of Rome Tor Vergata, Rome, Italy

    Roberto Miano

  4. Urology and Uro-Oncology Coordinator - CUF Hospitals, Lisboa, Portugal

    Estêvão Lima

  5. School of Medicine, University of Minho, Braga, Portugal

    Estêvão Lima

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  1. Luca Orecchia
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  2. Sara Anacleto
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  3. Stefano Germani
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  4. Roberto Miano
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  5. Estêvão Lima
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Editors and Affiliations

  1. Grande Ospedale Metropolitano, Reggio Calabria, Italy

    Domenico Veneziano

  2. Department of Urology, Hacettepe University, Ankara, Turkey

    Emre Huri

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Orecchia, L., Anacleto, S., Germani, S., Miano, R., Lima, E. (2021). Stone Treatment. In: Veneziano, D., Huri, E. (eds) Urologic Surgery in the Digital Era. Springer, Cham. https://doi.org/10.1007/978-3-030-63948-8_3

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  • DOI: https://doi.org/10.1007/978-3-030-63948-8_3

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