Percutaneous Nephrolithotomy

Abstract

Percutaneous nephrolithotomy (PNL) was first described by Fernstrom and Johansson in 1976 [1]. Improved surgical instruments and endourologic techniques developed in the ensuing decade allowed the procedure to gain widespread acceptance [2,3]. Today, PNL in conjunction with shock wave lithotripsy (SWL) has replaced open-stone surgery at most institutions. Patient comfort has been improved by combining previously separate steps in the PNL procedure into a single setting. Retrograde placement of a ureteral catheter, percutaneous access, and stone removal are all performed in the operating room under a single anesthetic by the urologist. This also avoids becoming dependent on another person’s skill and schedule and allows the flexibility to perform additional renal access procedures when required. Although other specialists may be capable of performing renal access, it is the urologist who should decide which site provides the best access to the stone.