Percutaneous Lithotripsy: Indications

Although percutaneous nephrolithotomy (PCNL) is more invasive than extracorporeal lithotripsy (ESWL) it still plays an important role in the treatment of renal stones and indications to PCNL are mainly the cases where ESWL gives poor outcome results. When considering the indications to treat a patient affected by a renal stone, we have to evaluate factors related to: the stone, the kidney, the patient, the instruments and finally the urologist. We believe that elective indications to PCNL are: a stone burden >2cm; staghorn and complex stones; stones in hydronephrotic kidneys or associated to UPJ obstruction; lower calyceal stones when >10 mm or in a calyx with an unfavorable anatomy; ureteral stones impacted in the UPJ with severe hydronephrosys; stones in caliceal diverticula.