ABSTRACT
Percutaneous nephrolithotomy (PCNL) has evolved considerably since Rupel and Brown (1) first removed a renal stone through a nephrostomy tract in 1941. Fernstrom and Johansson established PCNL as an accepted surgical technique performing a nephrostomy tract strictly for removing a stone in 1976.(2) It was only after 1979, that Smith, Alken, and Clayman popularized the technique and became pioneers in the field of endourology.(3-5)
As the percutaneous era continued, the indications for this advanced technique began to expand and could be utilized for more complex renal stones along with the growing experience. The advent of effective intracorporeal lithotripsy devices such as ultrasound also contributed to this expanding role. Extracorporeal shock wave lithotripsy (ESWL) developed concurrently to PCNL. Lingeman and Newman in 1986 reported stone-free rates of 95% for stones less than 1 cm, 87% for stones between 1 and 2 cm, 48% for stones between 2 and 3 cm and 35% for stones larger than 3 cm with shock wave lithotripsy.(6)
Percutaneous nephrolithotomy demonstrated obvious advantages when compared to ESWL in regards to stone-free status for complex stone problems (7, 8) and proving its superiority in removal of larger stones with minimal morbidity.(9)
The indications for PCNL have evolved to include (10, 11):
· Stone size >2 cm · Hard stones such as cystine stones · Lower pole stones >1 cm · Infection stones and staghorns · Failure of contraindications to shock wave lithotripsy · Patients with renal anatomic variations · Certainty of final result
This chapter will examine in detail the current indications for percutaneous nephrolithotomy and outline the technique of PCNL.
