Percutaneous Stone Removal

Percutaneous nephrolithotomy (PCNL) revolutionized stone surgery decades ago. However, it is still a challenging surgical technique that requires professional preparation and knowledge of possible problems and their solutions.We illuminate the recent literature on indications for PCNL, preoperative diagnostics, required patient preparation, and the different techniques of the whole procedure, including positioning the patient, gaining access to the collecting system, disintegrating the stone, and finishing the operation. All up-to-date discussions are included. Recognition and handling of possible complications are described in detail.PCNL is one of the most powerful instruments of the urologist for stone treatment. In an expert's hands, the procedure is gentle, fast, and efficient. To become an expert, continuous training with supervision is necessary. However, further development of instruments and techniques enables surgeons to perform more complex cases and to broaden the indications. To gain a successful performance, exact exploration and preparation of the patient is decisive. In the rare case of severe complications, a well-trained team of nurses, radiologists, and anesthesiologists is priceless.