PCNL in the twenty-first century: role of Microperc, Miniperc, and Ultraminiperc

The indications for PCNL have seen a paradigm shift in the past decade. In the earlier years, PCNL was done for large-volume stones such as complex multiple calyceal calculi, staghorn stones. The advent of miniaturization of instruments ushered in smaller scopes, smaller retrieval devices, and energy sources. The miniaturization of instruments also was responsible in the paradigm shift in the indications for PCNL. These miniaturized instruments and accessories obviate the need to dilate the tract beyond 20 Fr. Various studies in the past have confirmed that reducing the tract size potentially also reduces the complications of percutaneous surgery.

In this article, we discuss the new developments in percutaneous surgery in the past decade with emphasis on techniques of Microperc, Miniperc, and Ultraminiperc.

The newer techniques with Miniperc are suited for stones 1.5-2 cm in size. Microperc and Ultraminiperc may be suitable for stone sizes <1.5 cm. These are also suited for special situations such as diverticular stones and pediatric moderate-sized stones. The indications of these newer techniques compete with those of extracorporeal shockwave lithotripsy and flexible ureteroscopy.