Indications for PCNL

Abstract

Assuming a calculus requires removal, the indications for PCNL tend to be those calculi that cannot be safely or efficiently removed by the alternative methods, particularly FURS, ESWL, laparoscopy or have failed these treatments.Also with the advent of “mini PCNL”, the pendulum, particularly in India and Germany is swinging back towards PCNL for smaller renal and upper ureteric calculi.Currently the major indications for percutaneous nephrolithotomy are staghorn calculi with a large stone burden, calculi contained within an obstructed collecting system or a horseshoe kidney, infection associated calculi which require 100% clearance, complex stones within urinary diversions, calculi refractory to ESWL, those in congenital malformations, large impacted upper ureteric stones and those associated with a preexisting obstruction such as a calyceal stenosis or a pelvi ureteric junction obstruction, and those in patients whose occupation, such as an airline pilot require removal to perform their duty safely.These are discussed in detail in this chapter.