FUTURE OF KIDNEY STONE MANAGEMENT: Edited by Arkadiusz MiernikTract sizes in percutaneous nephrolithotomy does miniaturization improve outcome?Heinze, Alexandera,b; Gozen, Ali S.a; Rassweiler, JensaAuthor Information aDepartment of Urology, SLK Kliniken, Heilbronn, Germany bSchool of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico Correspondence to Alexander Heinze, MD, Department of Urology, SLK-Kliniken Heilbronn, Am Gesundbrunnen 20-26, D-74078 Heilbronn, Germany. Tel: +49 7131 4924001; fax: +49 7131 494724001; e-mail: [email protected] Current Opinion in Urology: March 2019 - Volume 29 - Issue 2 - p 118-123 doi: 10.1097/MOU.0000000000000574 Buy Metrics Abstract Purpose of review To provide a summary of surgical outcomes in percutaneous nephrolithotomy (PCNL) according to various techniques and tract sizes. Recent findings Recent literature in this field concluded that standard PCNL (sPCNL) remains the optimal treatment for stones between 1 and 2.5 cm and can be managed with tracts 14–20 F, whereas small stones less than 1.5 cm can be treated with tracts under 14 F. According to new datasets, smaller tracts can be equally effective in the treatment and might offer the possibility to reduce bleeding, length of hospital stay, postoperative pain as well as overall complication rates when compared with sPCNL. On the other hand, longer operative time as well as lower stone-free rates, which have been the main drawbacks of the miniaturized approach, have recently shown to be comparable with sPCNL. Summary At present, tract size is a highly debatable topic in percutaneous stone therapy. New systems for miniaturized PCNL have been developed to achieve comparable stone-free rates while reducing the incidence of common complications. The adoption of these techniques demands skilled surgeons and institutional investment for the acquisition of new equipment. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.