Percutaneous Management of Large Renal Calculi (Percutaneous Nephrolithotomy)

  • Karen L. SternEmail author
  • Shubha De
  • Manoj Monga


Percutaneous nephrolithotomy (PCNL) is the current standard of care for patients with a large stone burden. There are varying ways to perform PCNL, including different patient positioning, percutaneous access methods, and instrumentation. Endoscopic-guided percutaneous access in the prone split leg position combines flexible ureteroscopy with fluoroscopy to perform the renal puncture and tract dilation. This technique allows careful consideration of the renal anatomy and stone position. Pre-puncture stone manipulation can help simplify nephroscopy by repositioning stones from hard-to-reach calyces. This chapter will cover the indications and exclusion criteria for percutaneous surgery, while detailing the necessary equipment, positioning, and step-by-step methods to achieve endoscopic-guided renal access.


Percutaneous nephrolithotomy Renal access Endoscopic-guided renal access Lithotripsy Nephrolithiasis 


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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of UrologyGlickman Urological and Kidney Institute, Cleveland ClinicClevelandUSA
  2. 2.Department of UrologyMayo ClinicPhoenixUSA
  3. 3.Division of Urology, Department of SurgeryNorthern Alberta Urology Centre, University of AlbertaEdmontonCanada

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