Percutaneous nephrolitholapaxy: past, present, future...

Urolithiasis is a widespread disease which takes a leading place in the structure of surgical diseases of the urinary system. The basis for the development of urolithiasis are the disturbances of metabolic processes in the body. The average risk to acquire urolithiasis varies in the range of 5-10%. Staghorn nephrolithiasis is a severe form of kidney stones and takes 3 to 30% of all kidney stone cases. Following the technical progress, minimally invasive treatment methods are being actively implemented in urological hospitals. Extracorporeal and percutaneous nephrolithotomy replaces the traumatic open surgery and demonstrates a success to remove stones from the urinary tract. The main trends of the minimally-invasive techniques are minimization of operational trauma, preservation of functional ability of kidneys, low risk of intraoperative and postoperative complications and, as consequence, reduction in the analgesia and admission duration. This article is dedicated to the history of the treatment methods of this pathology. We review the modern methods of treatment of urolithiasis and in particular of the most severe forms, namely of the staghorn nephrolithiasis. We undertake the comparative analysis of the advantages and disadvantages of alternative minimally invasive therapy techniques for nephrolithiasis. The article widely covers all 3 stages of percutaneous nephrolithotripsy (1 - percutaneous access, 2 - stone destruction and extraction, 3 - drainage). Also disclosed scientific advances and clinical experimental developments for these three stages of the percutaneous therapy. Based on the data to the common complications and characteristics of the perioperative period, perspective directions are defined for further development of percutaneous surgery in a present time and up to a near future.