Perry Xu, MD, discusses PCNL’s role in the age of minimally invasive URS

When it comes to performing percutaneous nephrolithotomy (PCNL), Perry Xu, MD, told Urology Times® it’s “all about planning.”

“You absolutely need to have a CT scan prior to the surgery to best identify and really intimately understand the kidney’s anatomy when you're deciding to do a PCNL…Something I like to highlight is that nowadays, in modern CT scans, we have this tool called multi planar reformation. Previously, we were limited to coronal, axial and sagittal for our CT cuts and our ability to plan. But now that we have multi planar reformation, you can actually tilt the CT scan into an oblique view, so that you can actually see exactly where you want to go for your tract, so you can better identify the anatomy,” said Xu, an assistant professor of urology at Northwestern University Feinberg School of Medicine in Chicago, Illinois.

Xu also acknowledged that there has been discussion regarding PCNL’s role in the stone treatment landscape given the evolution of minimally invasive ureteroscopy.

“When you have a patient who's very motivated to remove all the stones in one sitting, and [does not want] any staged surgery, no matter what, then I would say percutaneous nephrolithotomy is definitely an option. Those who have anatomic restrictions, whether or not there's issues with ureteral access for any reason, whether or not they've had previous reconstruction, any stricture disease, any sort of congenital disease that would limit your ability to perform this in a retrograde approach, then definitely an integrated approach with PCNL is important. PCNL is still very safe in the right hands. If you're skilled and you have good ways to get access, it’s very helpful. And nowadays, there are even more tools out there that are making it easier to achieve access into PCNL as well,” Xu said.