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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 (<50, 50–100, >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.