Tract sizes in percutaneous nephrolithotomy: does miniaturization improve outcome?

To provide a summary of surgical outcomes in percutaneous nephrolithotomy (PCNL) according to various techniques and tract sizes.

Recent literature in this field concluded that standard PCNL (sPCNL) remains the optimal treatment for stones between 1 and 2.5 cm and can be managed with tracts 14-20 F, whereas small stones less than 1.5 cm can be treated with tracts under 14 F. According to new datasets, smaller tracts can be equally effective in the treatment and might offer the possibility to reduce bleeding, length of hospital stay, postoperative pain as well as overall complication rates when compared with sPCNL. On the other hand, longer operative time as well as lower stone-free rates, which have been the main drawbacks of the miniaturized approach, have recently shown to be comparable with sPCNL.

At present, tract size is a highly debatable topic in percutaneous stone therapy. New systems for miniaturized PCNL have been developed to achieve comparable stone-free rates while reducing the incidence of common complications. The adoption of these techniques demands skilled surgeons and institutional investment for the acquisition of new equipment.