Urolithiasis: Edited by Anup PatelNew developments in percutaneous techniques for simple and complex branched renal stonesCracco, Cecilia M; Scoffone, Cesare M; Scarpa, Roberto M Author Information Department of Urology, University of Torino, San Luigi Hospital of Orbassano (Torino), Turin, Italy Correspondence to Cesare M. Scoffone, MD, Department of Urology, University of Torino, San Luigi Hospital, Regione Gonzole 10, 10143 Orbassano, Turin, Italy Tel: +39 011 9026558; fax: +39 011 9026244; e-mail: [email protected] Current Opinion in Urology: March 2011 - Volume 21 - Issue 2 - p 154-160 doi: 10.1097/MOU.0b013e3283436d32 Buy Metrics Abstract Purpose of review Percutaneous nephrolithotomy (PNL), although practiced for almost 30 years, is still the most appropriate treatment modality for several forms of renal stones. We analysed a number of very recent advances in PNL technique, contributing to the continuous improvement of its efficacy and safety. Recent findings A thorough review of the recent literature identifies five major progressing areas, inspiring fruitful innovations in PNL technique: imaging (computed tomography being the standard tool) before, during and after the procedure; patient positioning (the traditional prone position being now challenged with the emerging supine positions); endoscopic combined intrarenal surgery (ECIRS), a versatile antero-retrograde approach to the upper urinary tract and a new comprehensive attitude of the urologist toward the various PNL steps; intracorporeal lithotripsy (improved by new devices combining ultrasonic and pneumatic lithotripsy, or ultrasonic and high-power holmium: YAG laser lithotripsy); and post-PNL tube management (namely nephrostomy-free and totally tubeless procedures). Summary Urologists dedicate significant efforts to the improvement of the PNL procedure, with the aim of further increasing its stone-free outcomes and reducing patient morbidity. Large-scale multicentre prospective trials are needed to define benefits and identify possible drawbacks of the described innovations in percutaneous stone management. © 2011 Lippincott Williams & Wilkins, Inc.