Renal stone disease is becoming increasingly prevalent globally. With a rise in stone disease worldwide, there is also a relative increase in the rates of surgical intervention. Technological advances have allowed a move towards minimising the complications rates and length of stay with a reduction in invasiveness and size of instruments. A trend for minimising the percutaneous tract size has been noted in percutaneous nephrolithotomy (PCNL) for renal stones. The management has shifted from open surgery to standard PCNL, mini-PCNL and the latest ultra-mini and micro-PCNL techniques. There is a need to compare outcomes for the ever-advancing technologies, such as the smaller calibre of instruments, to assess risk-benefit in practice. This review looks at outcome-based comparison of percutaneous procedures for urinary lithiasis with instruments <12Fr in size.