Will the advances in retrograde intrarenal surgery extinguish percutaneous nephrolithotomy for stones larger than 2 cm?

Since 1976, when percutaneous nephrolithotomy (PCNL) was first described (1), it has been an excellent choice of endourological treatment for large renal stones. In fact, both American Urological Association (AUA) and European Association of Urology (EAU) guidelines currently consider PCNL the preferred surgical approach to stones larger than 2 cm (2, 3). However, recent technological advances in retrograde intrarenal surgery (RIRS) including development of digital ureteroscopes and high-power lithotripsy generators result in better stone free rates (SFR) while offering less morbidity to patients, hence broadening the indications of this technique, including large and complex stones (4, 5). Better outcomes translate into an increasing number of RIRS worldwide (6), but bring about the question: will RIRS, ultimately, extinguish PCNL as the main surgical treatment for large stones? © 2023,International Braz J Urol. All Rights Reserved.