Percutaneous nephrolithotomy and its legacy

Objective: We review the indications of Percutaneous Nephrolithotomy (PNL), its safety and efficacy when applied to various patient groups as well as the different points of technique, giving emphasis on new tips and ongoing debates. Methods: A literature search was performed using MEDLINE database on PNL between 1980 and 2004. Results: Percutaneous nephrolithotomy (PNL) has been successfully and safely used to treat patients with renal stones for more than a quarter of a century. Still, the use of PNL in treating renal stones in different patient groups, such as children, obese patients, patients with renal congenital anomalies, patients who had previous open renal surgery and patients who have undergone renal transplantation are always of high interest. Simultaneous bilateral percutaneous nephrolithotomy seems to have a certain role in treating bilateral renal stones, especially when proficiency is achieved for unilateral PNL. Various aspects of the procedure such as patient positioning, renal access, the ideal dilating method, the type of nephrostomy tube used, as well as the actual need for drainage, have been debated. Conclusion: PNL is currently the procedure of choice for removal of large renal calculi. The need for well designed prospective randomized trials comparing PNL with alternative treatment modalities arises through the literature review. (C) 2004 Elsevier B.V. All rights reserved.