New developments in percutaneous techniques for simple and complex branched renal stones

Percutaneous nephrolithotomy (PNL), although practiced for almost 30 years, is still the most appropriate treatment modality for several forms of renal stones. We analysed a number of very recent advances in PNL technique, contributing to the continuous improvement of its efficacy and safety.

A thorough review of the recent literature identifies five major progressing areas, inspiring fruitful innovations in PNL technique: imaging (computed tomography being the standard tool) before, during and after the procedure; patient positioning (the traditional prone position being now challenged with the emerging supine positions); endoscopic combined intrarenal surgery (ECIRS), a versatile antero-retrograde approach to the upper urinary tract and a new comprehensive attitude of the urologist toward the various PNL steps; intracorporeal lithotripsy (improved by new devices combining ultrasonic and pneumatic lithotripsy, or ultrasonic and high-power holmium: YAG laser lithotripsy); and post-PNL tube management (namely nephrostomy-free and totally tubeless procedures).

Urologists dedicate significant efforts to the improvement of the PNL procedure, with the aim of further increasing its stone-free outcomes and reducing patient morbidity. Large-scale multicentre prospective trials are needed to define benefits and identify possible drawbacks of the described innovations in percutaneous stone management.