Video presents a case of percutaneous nephrolithotomy (PCNL) performed by Dr. Oleg Shapiro, urology, Upstate Medical University, Syracuse New York, USA. 55 year old patient with a history of stones with multiple ESWL and stenting procedures in the past. This patient had a 3.5 cm stone in the right kidney requiring surgical removal. PCNL is most commonly indicated for large stone burden. This is defined by the following: staghorn calculi, stone >2cm, multiple stones >1cm, proximal ureteral stone >1cm. PCNL should also be considered for difficult to treat stones: lower pole stones >1cm, calcium oxalate monohydrate and cystine stones, stones refractory to other treatments, stones in calyceal diverticulum, stones with UPJ obstruction or poor drainage like horseshoe kidneys.
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