Percutaneous Nephrolithotomy (PCNL) Surgery

Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large kidney stones (greater than 2 cm) that cannot pass through urine. This procedure involves making a small incision over the abdomen to access and remove the stones from the kidney.

Alternate Name for Percutaneous Nephrolithotomy

Kidney stone extraction

Body Location

Kidneys, ureters, and urethra

Type of Procedure

Percutaneous surgical procedure

Benefits of Percutaneous Nephrolithotomy

Compared to traditional surgical methods, PCNL offers several benefits:

  • Less invasive
  • Reduced bleeding
  • Faster recovery
  • Shorter hospital stay

Preparation Before the Percutaneous Nephrolithotomy Procedure

Before undergoing PCNL, several imaging tests are conducted, such as abdominal ultrasound, CT scans, or MRI, to locate the kidney stones. A mid-stream urine test is also required. Other tests may include:

  • Kidney function test
  • Complete blood count
  • Bleeding and clotting profile

How Percutaneous Nephrolithotomy is Performed

The procedure is done under general anesthesia to ensure the patient feels no pain. The patient is positioned on their stomach, and a small 1 cm incision is made in the back. A hollow tube is inserted into the kidney under X-ray guidance, and surgical tools are used to remove the stone.
A drainage nephrostomy tube is placed in the kidney, along with a urethral catheter to drain urine. The patient may stay hospitalized for 2-4 days, depending on their health condition. A post-surgery X-ray is taken to confirm the stone has been completely removed. A DJ stent is typically placed and removed after 2 weeks.

Follow-up After Percutaneous Nephrolithotomy

A follow-up appointment is scheduled one week after the surgery to monitor recovery. Tests are repeated to ensure the procedure was successful, and the catheter is removed after assessing kidney function. Antibiotics and painkillers are prescribed to prevent infection and manage pain.
If the patient experiences severe pain, fever, or infection, it is important to contact the urologist. After a few days, patients can begin to move around and gradually resume normal activities. Lifting heavy objects or engaging in strenuous activities should be avoided for some time after surgery.

Recovery After Percutaneous Nephrolithotomy

Recovery time varies depending on the patient’s overall health. It is common to experience blood-tinged urine for a few days after the surgery. However, if there is severe pain or bleeding, medical attention should be sought immediately.
Patients typically regain full function after two weeks, but it is important to continue rest and maintain a healthy diet to support recovery. Dietary adjustments may be recommended to prevent the formation of new stones. Maintaining adequate water intake helps flush out any remaining small stones and reduces the risk of further stone formation.

Risks Associated with Percutaneous Nephrolithotomy

Although PCNL is a safe procedure, there are some risks involved:

  • Post-operative bleeding, which may occur due to tissue injury or during the healing process
  • Post-operative infection, which can be treated with antibiotics
  • Failure to remove the stone, which may happen if the stone is broken into smaller pieces during the surgery
  • Tissue injury, which can occur when placing the tube or stent, potentially causing pain and bleeding

Frequently Asked Questions

  1. How long does a percutaneous nephrolithotomy (PCNL) surgery take?
    The surgery typically takes 1 to 3 hours, depending on the complexity of the case.
  2. Is percutaneous nephrolithotomy (PCNL) surgery painful?
    The procedure is performed under general anesthesia, so no pain is experienced during the surgery. However, mild discomfort and pain may occur during recovery, which can be managed with pain medications.
  3. What are the advantages of percutaneous nephrolithotomy (PCNL) surgery?
    The advantages of PCNL include:
  • Minimally invasive
  • High success rates
  • Shorter hospital stays
  • Reduced pain
  • Faster recovery compared to open surgery
  1. What is the success rate of percutaneous nephrolithotomy (PCNL) surgery?
    The success rate of PCNL is generally high, depending on factors such as stone size and location, the surgeon’s experience, and the patient’s overall health.
  2. Can percutaneous nephrolithotomy (PCNL) surgery be performed on both kidneys simultaneously?
    Yes, in certain cases, PCNL can be performed on both kidneys at the same time. This decision is based on the patient’s specific condition and is determined by the surgeon’s assessment.