Percutaneous nephrolithotomy (PCNL) is the standard of care for the management of large renal stone burdens. Residual stones after PCNL may be cleared with a second-look nephroscopy. Determining whether a patient should undergo a second-look procedure is based on both the intraoperative findings and the post-operative imaging. Aggressive intraoperative flexible nephroscopy, may reduce the need for routine second-look nephroscopy. Post-operative computed tomograpahy (CT) imaging is the most sensitive method for detecting residual stone fragments. When a clinically significant residual stone burden exists a second-look procedure may be performed in an effort to render the patient stone-free. In most instances the procedure can be performed in an ambulatory facility under conscious intravenous sedation. Future prospective study determining the threshold of fragment size after PCNL that warrants second-look nephroscopy is needed
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