PCNL was developed to reduce the morbidity and
mortality associated with open renal surgery, and it
currently remains the first-line treatment for large renal
stones. However, it represents the most morbid of the
minimally invasive endoscopic surgeries for renal stones.
Over the years, with the development of endoscopic
instruments and techniques, the role of ESWL and RIRS has
increased. Nevertheless, PCNL still has many advantages
over ESWL and RIRS in some cases. Currently, many efforts
and trials to reduce morbidity and increase the efficiency
and effectiveness of PCNL have furthered this procedure
technically and have broadened its indications. Recent
advancements that make PCNL a less-invasive technique
promise higher success rates and less perioperative
complications. Further efforts will be needed to validate
the many promising retrospective data by use of largescale
prospective studies and to develop this procedure more
safely and effectively.