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M. D’Armiento, R. Autorino, M. De SioPercutaneous Nephrolithotomy? Eur Urol. 2008. 24 yearsafter our first meeting in Milan, PCNL is a standardizedprocedure widely performed in most of the referral urologicalitalian centres. The current state of PCNL in Italycan be read on the official web pages of italian health caredepartment Ministero della Salute (1). Unfortunately justdata from 1999 to 2005 are available on line.In 2005, 2555 PCNL procedures were performed, 2513with a mean hospital stay of 8.11 days and 42 as dayhospital (Table 1).The most of the procedures, 1792, were done in AziendeOspedaliere, the equivalent of a tertiary care hospital.The shorter hospital stay is registered in completely privatehospitals, the longer in general hospital and teachinghospitals. Patients selection and economic issues canexplain the shorter hospital stay in private clinics whilethe limited patients volume and surgeon experience thelonger stay in general hospital.Comparing data through the years (Figure 1), a progressiveincrease in the number of the procedures performedfrom 1999 to 2005 can be observed.This should mean that the technique isappealing, is considered cost effective andthat either more patients are referred to tertiarycare centres, where the procedure isusually performed, or that more urologistshave learned and are utilising this surgicaltechnique.If we can positively comment the increasein the number of the procedures performedwe must remark that the hospitalstay during the same years has not sufficientlydecreased (Figure 2).A mean of 8 days has to be considered toolong for a minimally invasive technique.Maybe the slight increase observed in thelast two years could be related to the largernumber of urologists performing theprocedure that have not still reached a sufficientexpertise with PCNL and register ahigher complication rate.Analysing the data for each italian region(Table 2) a wide difference can be observed.In some of them no more than ten procedures/yearare performed and while a comparisonbetween 1999 and 2005 shows anincrease in the number of procedures inmost of the regions, in Trento province andin Basilicata the number is unfortunatelyreduced by almost 50%. And the lower thenumber of cases the longer is in general thehospital stay.Finally comparing the data of treatmentoptions for urolithiasis (Figure 3), there isa satisfactorily trend to an increase in therelative number of PCNL performed eachyear. 3% of the cases were percutanoussurgery procedures in 1999 versus 5% of2005. Still in 2005, 3% of the procedureswere pyelolithotomies or nephropyelolithtomies.In United States already in 2000open surgery represented no more thanFigure 2.Hospital stay for PCNL procedures from 1999 to 2005.Table 2.Comparison of the number of procedures and hospital stay between 1999and 2005 in each italian region.Selected procedure:Percutaneous nephrostomy with fragmentationRegional survey 2005Region N° patients Mean N° patients MeanHospital StayHospital StayPiemonte 42.0 9.41 104.0 7.75Valle D’Aosta 3.0 15.00 6.0 10.00Lombardia 231.0 10.20 427.0 8.05P.A. Bolzano 6.0 22.50 19.0 8.69P.A. Trento 26.0 17.81 14.0 9.36Veneto 258.0 9.10 308.0 7.86Friuli V.G. 45.0 9.09 68.0 8.43Liguria 35.0 11.52 58.0 9.28Emilia Romagna 163.0 8.15 285.0 7.11Toscana 32.0 7.88 106.0 8.06Umbria 4.0 9.75 5.0 12.20Marche 36.0 5.92 82.0 8.35Lazio 147.0 10.02 163.0 11.13Abruzzo 46.0 8.24 81.0 7.62Molise 2.0 15.00 26.0 13.12Campania 134.0 11.36 264.0 7.15Puglia 91.0 10.08 188.0 8.37Basilicata 9.0 5.45 4.0 5.0Calabria 36.0 8.56 29.0 10.76Sicilia 95.0 8.32 197.0 7.47Sardegna 18.0 12.95 79.0 7.4228Archivio Italiano di Urologia e Andrologia 2010; 82, 1