Renal Imaging Characteristics Predicting Percutaneous Access for Staghorn Stone Management

PURPOSE OF REVIEW: Preoperative planning in staghorn stones treated with percutaneous nephrolithotomy (PCNL) can improve efficiency and minimize complications. We summarized the current evidence on imaging features to guide the selection of optimal access for managing staghorn stones. RECENT FINDINGS: Although the upper pole may offer the most favorable route for stone clearance, it may carry a higher risk of complications in certain situations. In such cases, the middle-calyx may be a safer and equally efficient alternative. Multiple access may still be needed in certain cases. Care should be taken when analyzing preoperative imaging characteristics, as patient positioning and measurements may not directly correlate with the intraoperative findings. Detailed assessment of preoperative imaging remains essential for access planning and success. Linear stone burden, distribution of the stone and its relationships to the access calyx, nephrolithometry S.T.O.N.E. score, and infundibular width are relevant factors when planning PCNL access.