title: [Percutaneous Stone Treatment Today: Standard-, Mini-, Micro-, Ultramini-PCNL].
abstract: BACKGROUND
  Percutaneous nephrolithotripsy (PCNL) is one of the main interventional treatment modalities for large kidney stones (> 2 cm diameter). With the implementation of miniaturised techniques the indications for PCNL have been broadened to smaller stones. Especially for urologists without emphasis on endourology it is difficult to have an overview of the growing multitude of available systems and techniques. This article describes the currently available systems for percutaneous stone treatment with their peculiarities and indications.
  
  
  METHODS
  A PubMed-based literature search has been conducted. Relevant articles and additional manufacturers' literature have been compiled to create a summary of the different available PCNL systems. Furthermore, a brief literature review is given regarding indications, stone-free rates and complication rates of each system category.
  
  
  RESULTS
  Several manufacturers have developed different PCNL systems with varying diameters and special features. The indications for the different systems are overlapping. Retrospective studies showed reduced complication rates (especially less bleeding and need for transfusions) but prospective randomised controlled trials on this topic are still lacking. Assessed with the criteria of evidence-based medicine, the currently available evidence does not clearly answer the question whether a miniaturisation of PCNL systems is advantageous for the patient.
  
  
  CONCLUSIONS
  Invasiveness of PCNL can be reduced with the nowadays available miniaturised systems. The indication for PCNL has been broadened to small kidney stones > 1 cm diameter.
authors.affiliation: Klinik für Urologie, Department für Chirurgie, Universitätsklinikum Freiburg, Freiburg.
authors.forename: K
authors.initials: K
authors.lastname: Wilhelm
authors.affiliation: Klinik für Urologie, Caritas-Krankenhaus St. Josef, Universität Regensburg, Regensburg.
authors.forename: H-M
authors.initials: HM
authors.lastname: Fritsche
authors.affiliation: Abteilung für Urologie, Asklepios Klinik Barmbek, Hamburg.
authors.forename: C
authors.initials: C
authors.lastname: Netsch
mesh_terms: D004867:Equipment Design; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007669:Kidney Calculi / Q000628:therapy*; D008096:Lithotripsy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008904:Miniaturization / Q000295:instrumentation / Q000379:methods; D016896:Treatment Outcome; D018666:Ureteroscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*