Percutaneous nephrolithotomy is to create a channel from the skin to the kidney at the waist, through which the nephrolithoscope is inserted into the kidney and the kidney stones are broken and removed by using pneumatic ballistics, laser, ultrasound and other lithotripsy tools. This is called “perforation and extraction”. Percutaneous nephrolithotomy is a modern minimally invasive technique for kidney stone treatment, which was pioneered by our hospital in 2009. Indications Percutaneous nephrolithotomy is suitable for: kidney stones over 50px, kidney stones under 50px where extracorporeal lithotripsy is ineffective or with obvious hydronephrosis, and some upper ureteral stones. Technical advantages Surgical treatment of kidney stones include: open lithotripsy, extracorporeal lithotripsy, percutaneous nephrolithotripsy, soft ureteral lithotripsy, etc. The traditional “open stone extraction” method requires making a large incision of about 500px in the waist, cutting the muscle of the waist, separating the kidney and making a small incision in the renal pelvis or renal parenchyma to take out the stone. This method is highly invasive, bleeds more, is painful and has a slow recovery. It usually requires more than 7 days of hospitalization after the surgery. Because of the large surgical incision, not only is the skin unsightly, but the patient’s physical strength is more affected after surgery. Compared with open surgery, percutaneous nephrolithotomy has the advantages of less injury, less pain, complete stone extraction, and faster recovery. The incision in the lumbar region is usually less than 25px, and because no muscles are cut, it not only does not affect the aesthetics, but also has almost no effect on the work force after the procedure. The length of hospital stay after surgery is also significantly shorter. Compared with laparoscopic lithotripsy, percutaneous nephrolithotripsy has less impact on the kidney and surrounding structures and does not interfere with various subsequent kidney surgeries. Compared with extracorporeal lithotripsy, it has a shorter treatment period, immediate effect and less impact on kidney function. Technical features Percutaneous nephrolithotomy is a very technical procedure. As we know, the kidney is a very vascular organ, and the blood flow in the kidney accounts for 1/4 of the bleeding volume from the heart, and it requires very delicate surgical techniques to avoid bleeding as much as possible while trying to remove the stone and protect the kidney function. In some ways, this surgery is much more difficult than nephrectomy for kidney cancer. The procedure requires individualized treatment, which means that the location, size and composition of the stones should be determined according to the patient’s location, number, size and composition of the stones, as well as the size of the channel and the corresponding lithotripsy tools. Improper channel selection may increase the risk of bleeding, complications and stone remnants. This requires a very standardized treatment protocol and delicate operating techniques. Typical cases Case 1 Case 2