Renal access for PCNL: The smaller the better?

Although percutaneous nephrolithotomy (PCNL) has been considered as the gold standard for management of large renal stones, several issues such as severe complications and morbidity associated with renal access remain a matter of debate. To overcome these issues, many urologists investigated the risk factors of high morbidity and hypothesized that large tract size for renal access can be one of the major factors related to significant complications. Hence, there have been many endeavors and investigations to reduce the size of renal access tracts and to confirm the effectiveness and safety of smaller tract size for PCNL. Currently, miniaturized PCNL using a smaller nephrostomy tract for renal access has gained wide acceptance for the surgical treatment of small- or medium-sized renal stones; however, the efficacy of mini-PCNL is still controversial. In this chapter, we will review the recent literature related to miniaturized PCNL, such as mini-, ultramini-, and micro-PCNL, and discuss the practical advantages and drawbacks of these procedures compared to those of conventional PCNL.