Management of Renal Stones >2 cm in the Modern Endourology Era: Does PCNL Remain the Gold Standard?

Background

Percutaneous nephrolithotomy (PCNL) remains the reference treatment for renal stones larger than 2 cm because of its high single-session stone-free rate. However, advances in flexible ureteroscopy (fURS), laser lithotripsy, suction-assisted access systems, and endoscopic technology have expanded the role of retrograde intrarenal surgery (RIRS) in patients who historically would have been treated primarily with PCNL.

Objective

To critically review the contemporary roles of PCNL and RIRS in the management of renal stones >2 cm and evaluate whether advances in endoscopic and laser technologies have altered the traditional treatment paradigm.

Methods