Percutaneous nephrostolithotomy - What is its role in 1997?

Although extracorporeal shock wave lithotripsy achieves a high success rate in most patients with urolithiasis, percutaneous nephrostolithotomy (PNL) and other alternatives are required In some situations. This article outlines the indications for PNL, with special consideration of the size and location of calculi and the nature of the upper urinary tract. Staghorn calculi and calculi greater than 2 cm in diameter generally are best approached percutaneously. If composed of cystine or located in a lower pole calyx, smaller calculi sometimes also are treated best with PNL. There are several special situations, including abnormal renal anatomy, renal transplant kidneys, and upper urinary tract obstruction, in which PNL is the superior modality.