Urologia médica e cirúrgica
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Residual Stones after Percutaneous Nephrolithotomy

Mohamed F Abdelhafez

 Current EAU guide recommend the PCNL as the gold standard procedure for stones larger than 2 cm and stones larger than 1 cm if in the lower calyx in patients with unfavorable factors for SWL. Residual fragments are commonly seen after both, ESWL and after intracorporeal lithotripsy. The incidence of residual stones after PCNL ranges from 10% to 60%. But some of these studies with high success rate established the clinically insignificant residual fragments (CIRF) as being stone free. The ability to detect residual fragments is dependent on the imaging modality and this gives different outcomes when different modalities used to assess the stone free rate. Residual stones worth to be more studied because it gives rise to two major problems namely regrowth and recurrent urinary tract infection. The

residual stones may pass spontaneously; remain silent with no growth, become symptomatic with pain, heamaturia, infection and obstruction or act as a nidus and increase in size. Although routine imaging follow up is mandatory and is recommended by the EAU there are no current scheduled programs for follow up. In this mini review we tried to address the residual stones after PCNL in the literature regarding definition, incidence, diagnosis, fate and the possible methods of management.