Role of percutaneous procedures in the management of renal calculi.

Appropriate management of the variety of patients with stone disease demands access to all methods of stone removal. Percutaneous procedures are an integral aspect of the surgical management of stone patients, and the urologist must recognize when a patient's situation is best served by percutaneous surgery. Percutaneous stone removal procedures are preferred when: 1. The stone is large, i.e., greater than 2 to 3 cm. 2. The stone is staghorn in configuration, with percutaneous measures being used either as primary treatment or in combination with shock wave lithotripsy. 3. The stone is composed of cystine 4. When certain removal of the stone is important. 5. When there is obstructive uropathy. 6. When other modalities have failed. 7. In morbidly obese individuals and others whose body habitus precludes use of the shock wave machine. 8. In children, at least until the issue of long-term safety of extracorporeal lithotripsy is settled.