Multi-tract Percutaneous Nephrolithotomy approach

Percutaneous nephrolithotomy is still considered as first line treatment for large stones; there is no doubt that for staghorn stones it is a gold standard. From its beginning it underwent many changes and developments. However, there are specific technical aspects, that remain stable throughout the years: Obtaining the precise, planed and desired access to a specific calyx, precise puncture technique and proper tract formation, along with careful introduction of most suitable equipment, are key elements in all percutaneous procedeures, especially in complex cases. Complex cases are not only associated with the aforementioned, along with the number and sites of puncture, but also with the duration of the whole procedure. Although, the approach selection is case-dependent, there are two steps with established role in all cases: puncture and tract formation along with safety. In the present study we overview multitract PNL key steps.