Percutaneous Nephrolithotomy (PCNL)

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It is a surgical procedure to remove stones from the kidney through a small incision (cut) about ½ inch in the back. The urologist inserts a telescope (nephroscope) through the incision into the hollow part of the kidney to the stone (Fig. 1). The urologist then uses instruments to break the stone into pieces and removes them using suction (Video 1). PCNL is usually used in patients with large (more than 2 cm or 0.8 inches) or irregularly shaped kidney stones, infected stones, and stones that were not broken up by extracorporeal shockwave lithotripsy (ESWL) or by ureteroscopy.

Video 1 : PCNL Stone Removal

General anesthesia is usually used and typically you will need to stay about 2-3 days in the hospital.

Although considered to be safe and minimally invasive, PCNL may carry serious risks including, but not limited to: bleeding and the potential need for blood transfusion, infection and sepsis (bacteria spreading into the blood stream), injury to adjacent organs such as the bowels and liver, injury to the blood vessels going to the kidney, kidney failure, leakage of urine, conversion to open surgery and additional surgery or operations needed.

PCNL is one of the most effective techniques for making sure that patients are stone free after the procedure. Occasionally, additional procedures may be needed to remove a stone. Though PCNL requires a small incision, it is less invasive than a full open surgery to remove a large kidney stone.

You should discuss with your urologist other options including:

Your doctor will talk to you about the procedure (its indications, risks, benefits, alternatives, and likelihood of success) based on the size and location of the stone.
You will be given an opportunity to ask questions before you sign a consent form allowing the doctor to do the procedure.
Your doctor will do a history and physical exam and order diagnostic tests to make sure you are in good condition for the procedure.

The names and dosages of all medications that you are taking, including blood thinning medication (such as ibuprofen or aspirin), over-the-counter medications, and supplements.
- Be sure to ask if you need to stop any of these medications prior to the procedure and, if so, how many days should you stop them before the procedure
Of any allergies that you may have, including tape, latex, or contrast material
Of any bleeding disorders that you have
If you are or suspect that you pregnant
If you suspect that you have a UTI (you should have a negative (no growth) urine culture prior to having this procedure)
Be sure to not eat or drink anything after midnight or at least 8 hours prior to the procedure

Depending on the size and the location of the stones, it may take one to several hours.

You can expect to have a nephrostomy tube (a small tube coming out of your back to allow urine to drain from the kidney into a bag. The nephrostomy tube usually remains in place for 1-2 days.
You can expect to have aureteral stent inside the ureter, between the kidney and the bladder to help drain urine from the kidney. It is typically removed in your doctor's office in 1-2 weeks. You can expect to have a Foley catheter (a tube to drain urine from your bladder) for about 1 day.
It is important that you get out of bed and walk (with supervision from your nurse) the day after your surgery.
You should have a SCD (sequential compression device) applied to your legs when you are not walking to aid in the prevention of blood clots in your vein.
You may need a "second look" procedure to remove any remaining stones.
Your doctor may decide to remove the nephrostomy tube or send you home with the tube.
Avoid straining, heavy lifting, pushing or pulling for about two to four weeks. You may go back to work after about one week.

A fever over 101F or have chills. Usually this indicates you have an infection or possible obstruction of the urinary tract.
Severe bleeding (with thick blood like ketchup or blood clots)