Percutaneous nephrolithotomy

Abstract

Percutaneous nephrolithotomy (PCNL) is now the established approach to a large stone burden in both adult and pediatric patients, allowing stone removal with less morbidity, cost, and a shorter hospital stay when compared with open procedures. As PCNL has developed, the technique has been adapted and successfully applied to the complex situations of obesity, bilateral stones, and ectopic kidneys. In all situations the planning and successful execution of the initial access into the kidney relies on a detailed understanding of renal anatomy and is critical to the outcome of PCNL. A successful puncture both decreases PCNL complications and increases stone clearance rates. Complete stone clearance should be the aim of each PCNL procedure. This chapter highlights tips and tricks that can be used to improve stone clearance rates and enhance outcomes in patients undergoing this challenging procedure. © 2011 Springer-Verlag London Limited.