Recently, several scoring systems have been proposed to predict outcomes of percutaneous nephrolithotomy, objectively and quantitatively assessing kidney calculi complexity using cross-sectional imaging. These scoring systems are promising new tools that can guide surgical decision making, predict surgical outcomes, counsel patients undergoing stone surgery, and improve standardized academic reporting in percutaneous kidney stone surgery. In this article, we review features of each of these systems, their similarities and differences, and their applicability in clinical practice and relevance in academic reporting.