Percutaneous Renal Access: A Historical Perspective

Percutaneous nephrolithotomy (PCNL) has evolved to become the preferred minimally invasive approach for treating large-burden renal stones. This approach has replaced open renal surgery for stones. It has also evolved into a treatment option for treating noninvasive urothelial tumors of the upper urinary tract. Current percutaneous access techniques involve fluoroscopic or ultrasound guidance with a small-gauge needle for initial access. In selected cases, computed tomography (CT) guidance or blind access by anatomical landmarks may be indicated. The complications of PCNL are minimal and the associated morbidity is far less than for open renal surgery.