Percutaneous Nephrolithotomy (PCNL)

PCNL is a procedure used to treat kidney stones.

Kidney stones occur in the urinary system when chemical molecules in urine crystallize. PCNL is a procedure for removing stones in the kidney or upper ureter (the tube that drains urine from the kidney to the bladder) that are too big for conventional stone removal methods like shock wave lithotripsy or ureteroscopy.

The Surgery

This technique has been done on a considerable number of patients in recent years and is now considered the standard of care for patients with kidney stones that are big, particularly hard, or resistant to other types of stone therapy. As a result, it has replaced open procedures for kidney stones in the great majority of patients.

Typically, the procedure takes three to four hours. The procedure involves creating a tiny 1 cm incision in the patient’s flank (Figure 1). An x-ray is used to guide the placement of a catheter through the incision into the kidney. A tiny telescope is then inserted through the tube to visualize the stone, break it up, and extract it from the body. If required, a laser or another equipment known as a lithotripter may be used to break up the stone before it is removed. In comparison to open stone surgery, this approach has resulted in much reduced post-operative discomfort, a shorter hospital stay, and an earlier return to work and everyday activities.

This approach also has a greater success rate for removing all stones in a single setting than other methods, such as extracorporeal shock wave lithotripsy (ESWL), which sometimes need many efforts.

Potential Risks and Complications

Although this operation has been shown to be quite safe, as with any surgical procedure, there are risks and possible problems. The safety and complication rates are comparable to those of open surgery. Potential dangers include:

• Bleeding: While this operation may cause some blood loss, patients seldom need to have a blood transfusion. If you are interested in autologous blood transfusions (donating your own blood), you must notify your surgeon. 
• Infection: To reduce the risk of infection after surgery, all patients are given broad-spectrum antibiotics. If you have any indications or symptoms of infection after surgery (fever, discharge from the incision, urine frequency or discomfort, pain, or anything else you are worried about), please call us immediately.
• Tissue/Organ Injury: Although rare, injuries to surrounding tissue/organs such as the colon, vascular structures, spleen, liver, lung, pancreas, and gallbladder may need further surgery. Kidney failure is uncommon, although it is a possibility. Scar tissue may potentially develop in the kidney or ureter, necessitating additional surgery.
• Conversion to open surgery: If complications arise during this surgical treatment, it may be necessary to convert to regular open surgery. This might result in a bigger conventional open incision and a lengthier recovery time.
• Failure to Remove the Stone: It is possible that the stone(s) will not be entirely removed, owing to its size or position. Additional therapy may be needed.