Long-term results of percutaneous nephrolithotomy: does prophylactic medical stone management make a difference?

It has been almost 30 years since the introduction of percutaneous nephrolithotomy (PCNL) as a safe, effective, and efficient method for large stone fragmentation and removal. While considered a highly effective technique, a surgical procedure alone cannot address the underlying metabolic conditions that may cause either new stone formation or regrowth of residual stones. Reviewing the English literature reveals a relative paucity of controlled studies that explore the long-term effects of metabolic evaluation and medical management on stone recurrence rates. Yet, when retrospectively analyzing the present data, one can see that metabolic and environmental factors are of paramount significance. Medical stone prophylaxis should not be overlooked, because the proper establishment of medical therapy after PCNL may result in stabilization of stone disease and prevention of the need for further surgical procedures for stone removal.