Introduction: The goal of percutaneous nephrolithotomy (PCNL) is to ensure complete stone clearance with minimal morbidity. The key to complete clearance is accurate technique, expertise and instrumentation.
Methods: We systematically reviewed available reports that were identified using a PubMed/Medline search. The keywords used were 'PCNL' and 'advances in PCNL'. The findings were reviewed under the topics of newer developments in imaging, techniques and a review of outcomes with an emphasis on stone clearance and complications.
Conclusion: The newer developments in imaging methods, such as cone-beam computed tomography and staghorn morphometry, help the surgeon to plan the procedure for a safe and better outcome. The highlight of these newer developments is the miniaturisation of instruments. This has translated into developing newer techniques such as the 'microperc' and 'miniperc'. The data-collection initiative by the Clinical Research Office of the Endourological Society has helped in obtaining a high level of evidence.
Keywords: Advances; CBCT, cone-beam CT; CROES, Clinical Research Office of the Endourological Society; HU, Hounsfield unit; Kidney stones; Microperc; Miniperc; Outcome; PCNL; PCNL, percutaneous nephrolithotomy; RIRS, retrograde intrarenal surgery.