Training in percutaneous nephrolithotomy: The learning curve and options

Objective:
To review the current approach to training and the learning curve for percutaneous nephrolithotomy (PCNL), and to formulate a recommendation for structured PCNL training for the urologist in-training.

Methods:
Publications related to PCNL training, simulator training, surgical training and working-hour restrictions on surgical training were reviewed.

Results:
The key components for a successful PCNL training programme should include stages for acquiring basic knowledge related to the procedure, acquiring basic skill in various training models, and acquiring clinical experience under supervised clinical practice. Lastly, life-long continuous learning would be important to maintain the practising standard.

Conclusion:
Despite being one of the main endoscopic procedures for managing stones, PCNL remains a difficult procedure with a long period of learning. Facing the challenge of working-hour restrictions on training, a more structured training programme, together with the use of models, would improve the learning curve for PCNL.