Percutaneous nephrolithotomy (PNL) is a gold standard for the management of stones in the kidney. PNL offers good clearance rates with minimal morbidity. The key to success in a PNL includes proper patient selection and technique. The factors to be considered while selecting the patient for PNL include the stone size, location, and the pelvicalyceal anatomy. In this chapter, we discuss the indications and the technique of PNL. PNL offers good clearance rates with minimal morbidity with proper patient selection and technique. The current indications for PNL include stone size larger than 2 cm, staghorn calculi and multiple complex calculi, lower polar stones larger than 1 cm, stones in calyceal diverticula, and stones in horseshoe kidney, malrotated, pelvic kidneys. A perfect percutaneous renal access is “key” to success. The choice of access may be fluoroscopic or ultrasound-guided. PNL in patients with chronic kidney disease requires strategic preoperative, intraoperative, and postoperative planning.
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