International Alliance of Urolithiasis (IAU) consensus on miniaturized percutaneous nephrolithotomy
Authors: Zeng Guo-Hua , Zhong Wen , Mazzon Giorgio , Zhu Wei , Lahme Sven , Khadgi Sanjay , Desai Janak , Agrawal Madhu , Schulsinger David , Gupta Mantu , Montanari Emanuele , Martinez Juan Manuel Lopez , Almousawi Shabir , Malonzo Vincent Emanuel F. , Sriprasad Seshadri , Chai Chu Ann , Arumuham Vimoshan , Ferretti Stefania , Kamal Wissam , Xu Ke-Wei , Cheng Fan , Gao Xiao-Feng , Cheng Ji-Wen , Somani Bhaskar , Duvdevani Mordechai , Git Kah Ann , Seitz Christian , Bernardo Norberto , Ibrahim Tarek Ahmed Amin , Aquino Albert , Yasui Takahiro , Fiori Cristian , Knoll Thomas , Papatsoris Athanasios , Gadzhiev Nariman , Zhanbyrbekuly Ulanbek , Angerri Oriol , Ramos Hugo Lopez , Saltirov Iliya , Moussa Mohamad , Giusti Guido , Vicentini Fabio , Suarez Edgar Beltran , Pearle Margaret , Preminger Glenn M. , Wu Qing-Hui , Durutovic Otas , Ghani Khurshid , Maroccolo Marcus , Brehmer Marianne , Osther Palle J. , Zawadzki Marek , Tursunkulov Azimdjon , Kytaibekovich Monolov Nurbek , Abuvohidov Abdusamad Abdukakhorovich , Lara Cesar Antonio Recalde , Noori Zamari , Zanetti Stefano Paolo , Shrestha Sunil , de la Rosette Jean , Denstedt John , Ye Zhang-Qun , Sarica Kemal , Choong Simon 
Published: October 2024

Over the past three decades, there has been increasing interest in miniaturized percutaneous nephrolithotomy (mPCNL) techniques featuring smaller tracts as they offer potential solutions to mitigate complications associated with standard PCNL (sPCNL). However, despite this growing acceptance and recognition of its benefits, unresolved controversies and acknowledged limitations continue to impede widespread adoption due to a lack of consensus on optimal perioperative management strategies and procedural tips and tricks. In response to these challenges, an international panel comprising experts from the International Alliance of Urolithiasis (IAU) took on the task of compiling an expert consensus document on mPCNL procedures aimed at providing urologists with a comprehensive clinical framework for practice. This endeavor involved conducting a systematic literature review to identify research gaps (RGs), which formed the foundation for developing a structured questionnaire survey. Subsequently, a two-round modified Delphi survey was implemented, culminating in a group meeting to generate final evidence-based comments. All 64 experts completed the second-round survey, resulting in a response rate of 100.0%. Fifty-eight key questions were raised focusing on mPCNLs within 4 main domains, including general information (13 questions), preoperative work-up (13 questions), procedural tips and tricks (19 questions), and postoperative evaluation and follow-up (13 questions). Additionally, 9 questions evaluated the experts’ experience with PCNLs. Consensus was reached on 30 questions after the second-round survey, while professional statements for the remaining 28 key questions were provided after discussion in an online panel meeting. mPCNL, characterized by a tract smaller than 18 Fr and an innovative lithotripsy technique, has firmly established itself as a viable and effective approach for managing upper urinary tract stones in both adults and pediatrics. It offers several advantages over sPCNL including reduced bleeding, fewer requirements for nephrostomy tubes, decreased pain, and shorter hospital stays. The series of detailed techniques presented here serve as a comprehensive guide for urologists, aiming to improve their procedural understanding and optimize patient outcomes.