The Current Status of Percutaneous Nephrolithotomy

There have been remarkable advances in the field of endourology in the past century. This paper aims to provide practice updates in percutaneous nephrolithotomy (PCNL), ranging from preoperative to postoperative considerations.

PCNL remains the gold standard surgery for the treatment of stones larger than 20 mm and patients with complex anatomy. Patient positioning, device selection for stone treatment, and modality of access remain largely dependent on the surgeon’s training and preference. There has been a general widespread movement towards miniaturization of renal access tract, tubeless PCNL, and ambulatory PCNL (aPCNL) over the past two decades.

Advances in technology and surgical technique have allowed for safer PCNL surgery while maintaining excellent efficacy. The culmination of this progress has created a shift towards aPCNL, which may evolve into the standard of care for most complex stone surgery.