Percutaneous Management of Urinary Calculi

The revolution of minimally invasive surgery began in 1976 when Fernstrom and Johannson performed the first percutaneous nephrolithotomy (PNL). Urologists then began to realize the potential of renal surgery through small percutaneous tracts, and have refined the procedure into what is routinely practiced throughout the world today. Progress in this area has ultimately benefited patients, with reduced morbidity, convalescence and recovery. In the United States, endourology was pioneered by Smith and associates, who, in 1979, removed renal and ureteral stones through the percutaneous route. Recent advances in fiberoptic technology have allowed easier and safer access to the upper urinary tract from a retrograde approach. Another innovation in stone management is shockwave lithotripsy, which has been shown to be both safe and effective. However, there is a definite role for percutaneous management of urinary calculi in today's world. Developments in stone fragmentation, newer instruments, and improved fluoroscopy have increased the versatility of percutaneous surgery. Flexible, steerable nephroscopes have allowed access to all parts of the kidney. The indications for open surgery in stone disease have thus become rare. In 1990, only 1-2% of urinary stones were treated by open surgery. Today, this number is even smaller. This article will discuss the selection of the proper patient, as well as techniques of stone removal, and will review the advances and outcomes of percutaneous endourologic surgery in the last twenty years.