Current trends in percutaneous nephrolithotomy: an internet-based survey

Background: The aim of this study was to report current practices of percutaneous nephrolithotomy (PCNL) among endourologists. Methods: An internet survey was administered to Endourological Society members. Responders were distributed into three groups according to the number of PCNL cases per year (100). PCNL technical details as well as opinions regarding specific clinical case scenarios were evaluated and compared between groups. Results: We received 300 responses from 47 different countries. Prone position was used in 77% of cases, while 16% used supine position and only 7% used modified lateral decubitus. Most endourologists performed their own access. There were no significant differences between the three groups regarding patient position ( p = 0.1), puncture acquisition by urologist or radiologist ( p = 0.2) and fluoroscopic puncture technique ( p = 0.2). Endourologists with high annual PCNL practice (>100) had least probability to utilize nephrostomy tube ( p = 0.0005) or use balloon dilator ( p = 0.0001). They also had the highest probability of performing mini-PERC ( p = 0.0001). Conclusions: The majority of endourologists performing PCNL obtain their own access. Prone positioning is predominant, while totally tubeless PCNL are uncommon. Mini-PERC is gaining more popularity among endourologists. Most endourologists follow the guidelines for their choice of treatment modality in different sizes and locations of upper tract calculi