Percutaneous Nephrolithotomy Procedure
Overview
Percutaneous nephrolithotomy (PCNL surgery) is a medical procedure that removes kidney stones that are too large to exit the body naturally. The surgeon makes a small cut in the back to create a pathway directly to the kidney.
A thin tube and specialized tools are inserted through this passage to find and remove the stones. Doctors often choose this method when other less-invasive methods do not work.
Key Features of PCNL Surgery:
- Removes large or difficult kidney stones.
- Uses a cut less than an inch long.
- Avoids the need for open surgery.
Reasons for Performing the Procedure
Doctors use percutaneous nephrolithotomy when kidney stones are very large, block more than one area of the kidney, or cannot be treated using simpler methods. It helps treat staghorn stones and stones over 2 centimeters wide. Surgeons may also recommend this procedure if a stone is stuck in the ureter or when other treatments have failed.
Common Reasons
| Condition | Description |
|---|---|
| Large kidney stones | Stones larger than 2 centimeters. |
| Staghorn stones | Stones are obstructing the primary branches of the kidney. |
| Stones in the ureter | Especially if causing blockage. |
| Failed previous treatments | Other methods were not successful. |
Possible Complications
Although percutaneous nephrolithotomy is generally safe and effective, like any surgical procedure, it carries certain risks.
- Bleeding: Moderate bleeding is common and usually controlled during the procedure. However, in some cases, excessive bleeding may occur, requiring a blood transfusion or, rarely, angiographic embolization.
- Infection and Fever: Bacteria released during stone removal may lead to a urinary tract infection (UTI) or sepsis. Patients are typically given prophylactic antibiotics to reduce this risk.
- Pain and Nausea: Postoperative discomfort or pain at the incision or kidney site is common. Nausea may also occur due to anesthesia or medications.
- Urinary Urgency or Frequency: Feeling the need to urinate more often or urgently is typically temporary and resolves as the kidneys and urinary tract heal.
Other less common problems include injury to the kidney or nearby organs. Sometimes, the surgeon cannot remove all stones.
Getting Ready for the Procedure
Patients usually have blood and urine tests to check for infection or other issues. A CT scan helps doctors find where the kidney stones are. Patients should tell the medical team about all medicines, vitamins, or supplements they take. Sometimes, certain medications must be paused before the operation.
Doctors sometimes give antibiotics to help prevent infection after the procedure. Occasionally, the care team may discuss a catheter or nephrostomy tube as part of post-surgery care.
What You Can Expect
Most patients undergo percutaneous nephrolithotomy in a hospital setting under general anesthesia. This means they are fully asleep and do not feel pain during the procedure. Sometimes, the process begins in the radiology area before moving to the main operating room.
In such cases, local anesthesia may be used first to numb only a small part of the body where the initial step takes place. General anesthesia is then administered for the main surgery. Hospital staff will explain what to expect and provide clear instructions, including when to stop eating or drinking before surgery. Other preparations can include:
- Preoperative imaging tests like a CT scan or ultrasound to check the location and size of kidney stones.
- Reviewing any allergies, especially to anesthesia or medications.
- Speaking with the care team about regular medicines, especially blood thinners.
What Happens During Surgery
The surgeon or radiologist begins by inserting a special needle into the part of the kidney where urine collects. Imaging—such as ultrasound, CT, or X-ray—guides the needle accurately into the right spot. Sometimes, this imaging is done directly in the operating room.
Next, the care team places a catheter through the urethra, bladder, and up the ureter to the kidney. This helps the doctor see inside the urinary tract by sending a contrast material into the kidney. A thin tube called a sheath is then positioned over the needle’s path.
The surgeon uses this passage to insert surgical tools that break up and remove kidney stones. The main tool, a nephroscope, provides a view inside the kidney to reach the stones. Sometimes, a tiny camera is used for better visualization. Once the kidney stones are removed, the doctor might place either a nephrostomy tube or a ureteral stent.
| Tube/Device | Main Use |
|---|---|
| Nephrostomy tube | Helps urine drain directly from kidney |
| Ureteral stent | Keeps ureter open; aids urine flow to bladder |
These tubes make draining urine easier in the first days after surgery. Sometimes, the care team needs to check for remaining stone fragments or evaluate the urinary tract again during recovery. The team sends the collected kidney stones for analysis to help guide future care.
Recovery and Follow-Up After Surgery
Patients usually stay in the hospital for about one to two days for monitoring. During this time, care staff watch for signs of bleeding, infection, or other problems. The hospital team also monitors output from any drainage tube left in place. After going home:
- Avoid lifting heavy objects, pushing, or pulling for two to four weeks.
- Return to work is often possible after about seven days, depending on how quickly healing progresses.
- Track any changes in urine or drainage, such as blood or clots that look like thick, red ketchup. Report any of these signs to a doctor or the emergency room.
- Watch for symptoms like fever or chills, as these can signal an infection and may require urgent care.
- Pain is normal, but if pain medication does not help, follow up with the care provider.
Most people can slowly return to normal activities as discomfort lessens and any tubes, if placed, are removed. Follow-up imaging, such as ultrasound, may be done later to check for any remaining stones.
Findings
After the procedure, patients schedule a follow-up appointment with their surgeon about 4 to 6 weeks later. Sometimes, if a nephrostomy tube is used for kidney drainage, an earlier visit may be needed.
If the nephrostomy tube is still in place, the care team removes it after giving local anesthesia. Blood tests may help identify the cause of kidney stones, and patients often receive advice on how to avoid future stones.
