Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure to remove large kidney stones. A small incision (1 cm) is made in the back, and a nephroscope (thin camera) is passed directly into the kidney to break and remove the stone. PCNL is the treatment of choice for large stones (greater than 2 cm), staghorn calculi (stones filling the kidney collecting system), and stones that cannot be treated effectively with ESWL or ureteroscopy.
When is PCNL Done?
- Large kidney stones greater than 2 cm in diameter
- Staghorn calculi — large stones that fill the renal pelvis and calyces
- Stones that fail to respond to ESWL (lithotripsy) or ureteroscopy
- Stones in abnormal kidney anatomy (horseshoe kidney, pelvic kidney)
- Infected stones requiring urgent removal
- Multiple stones in one kidney that need simultaneous treatment
The Procedure
Anaesthesia
General anaesthesia is given. You lie face down (prone position) on the operating table. The kidney is visualised with ultrasound or fluoroscopy.
Access Creation
A thin needle is passed through the skin of the back into the kidney under imaging guidance. A guidewire is passed through the needle, and the tract is dilated to allow entry of the nephroscope.
Nephroscope Insertion
A nephroscope (thin telescope) is passed through the dilated tract into the kidney. The stone is directly visualised on a monitor.
Stone Fragmentation
The stone is broken using a lithoclast (pneumatic), ultrasonic, or laser energy. Fragments are extracted using baskets and graspers. For very large stones, a flexible nephroscope may be needed to reach all calyces.
Completion
A nephrostomy tube (small drain) may be placed at the end to ensure urine drainage and allow follow-up access if needed. The procedure takes 1-3 hours depending on stone complexity.
Preparation
- •Pre-operative blood tests — CBC, kidney function, coagulation profile
- •CT scan of abdomen — to map the stone and plan access route
- •Urine culture — infection must be treated before surgery
- •Stop blood thinners as directed by Dr. Goel
- •IV antibiotics may be given before surgery if infection is suspected
- •NPO (nil by mouth) for 6-8 hours before anaesthesia
- •Crossmatch blood in case transfusion is needed
Recovery
- Hospital stay: 2-4 days
- Nephrostomy tube: removed after 1-2 days if urine is clear and follow-up X-ray is satisfactory
- Return to normal activities: 2-3 weeks
- Avoid heavy lifting for 4-6 weeks
- Mild blood in urine is normal for 1-2 weeks
- Follow-up X-ray or CT to confirm complete stone clearance
- Stone analysis is done to guide prevention strategies
Advantages Over Open Surgery
Large Kidney Stones? Consult Dr. Goel
Dr. Rajesh Goel evaluates kidney stone cases and recommends the most appropriate treatment — whether PCNL, ureteroscopy, or lithotripsy — based on stone size, location, and your overall health.