Dear editor,The first extraction of a renal calculi through a percutaneous nephrostomy(PCNL)was described in 1976 by Fernstro¨m and Johansson[1].Through the collaboration of urology and interventional radiology,several innovations were later made to improve what we know today as PCNL[2].Ever since PCNL was introduced,the basic concepts for stone treatment with a nephroscope were the need for good visualization,a method to fragment larger stones,and a mechanical means to remove the fragments.Initially we started with a 30-French instrument to meet those goals;the concept was to have a large enough channel to remove 1 cm stone fragments.This decision was arbitrary at the time,and not evidence based.
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