Percutaneous Nephrolithotomy: Procedure, Risks, and Recovery
Essential guide to percutaneous nephrolithotomy, a key procedure for removing large or complex kidney stones when less-invasive methods fail.
Percutaneous Nephrolithotomy: Comprehensive Procedural Guide
Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure designed to remove kidney stones that are too large, complex, or otherwise unable to pass naturally or be treated with less invasive methods. With advances in medical imaging and surgical technique, this procedure offers a highly effective solution for significant urinary tract stones, improving patient outcomes and reducing recurrence rates.
Overview of Percutaneous Nephrolithotomy
PCNL derives its name from “percutaneous,” meaning “through the skin,” and “nephrolithotomy,” referring to the surgical removal of kidney stones. During PCNL, a urologist or interventional radiologist creates a path directly from the skin on the back to the kidney. Using specialized instruments, stones are located and removed through a tiny tube inserted into the kidney’s collecting system via a small incision. This method is most commonly reserved for large stones or when other treatments—such as extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy—are unsuccessful or unsuitable.
- Indicated for stones that won’t pass on their own
- Minimally invasive: requires only small incisions
- Often preferred for large or complex stones
Indications: Why Percutaneous Nephrolithotomy Is Done
PCNL is typically recommended when kidney stones meet criteria that make other treatments less feasible or effective:
- Staghorn Stones: Large stones branching into multiple sections of the kidney’s collecting system
- Stone Size: Stones larger than 0.8 inches (2 centimeters) in diameter
- Location: Large stones located in the ureter (the tube connecting kidney and bladder)
- Treatment Failure: When previous therapies (ESWL, ureteroscopy) have failed
| Indication | Reason for PCNL |
|---|---|
| Staghorn calculi | Block multiple branches, cannot be treated with less-invasive methods |
| Large (>2 cm) stones | Too big for natural passage or smaller therapies |
| Large ureteral stones | Obstruct urinary tract, risk of kidney damage |
| Treatment failure | Other procedures are unsuccessful or contraindicated |
Risks and Possible Complications
As with any surgical procedure, PCNL carries risks. Knowing these helps patients and their care teams prepare and mitigate potential complications:
- Bleeding: Blood loss is a common risk; sometimes, transfusion is needed.
- Infection: Risk of urinary tract or wound infection; antibiotics are often prescribed.
- Injury: Rarely, nearby organs or kidney tissue can be injured during the procedure.
- Incomplete Removal: Fragments of stones may remain and require further treatment.
It’s vital to discuss these risks with your care provider to make informed decisions about your treatment.
Preparation: Getting Ready for Percutaneous Nephrolithotomy
Preparing for PCNL involves several steps to optimize outcomes and reduce complications:
- Preoperative Testing: Blood and urine tests—to check for infection and evaluate kidney function; imaging (often CT scan) to locate stones
- Antibiotics: Prescribed before the procedure to lower infection risk
- Anesthesia Assessment: The procedure is typically performed under general anesthesia; the patient is fully asleep and does not feel pain.
Sometimes an initial part of the procedure is done under local anesthesia in radiology; you remain awake but do not feel pain, and then general anesthesia is administered in the operating room.
What to Do Before Surgery
- Inform your doctor of all medications, supplements, and allergies
- Follow fasting instructions as advised by your surgical team
- Arrange transportation and post-hospital care, as you’ll be recovering for several days
The Procedure: Step-by-Step
PCNL typically unfolds in several coordinated stages, involving radiologists and urologists working together to access and clear the kidney stones.
Before the Procedure
- Imaging (CT, X-ray, or ultrasound) is used to identify stone location and guide access.
- Local anesthesia may be administered if the initial access is made in radiology; otherwise, general anesthesia is provided in the operating room.
During the Procedure
- A specialized needle is inserted into a urine-collecting chamber (calyx) of the kidney.
- Imaging (X-ray, CT, or ultrasound) helps guide the needle to the correct spot.
- In some cases, a catheter is passed through the urethra, bladder, and ureter; this can assist with visualizing the kidney and guiding stone removal.
- A tube (“sheath”) is placed along the needle’s path, creating a channel for instruments.
- The stones are broken up using special instruments and then removed through the sheath.
- A nephrostomy tube may be left in place for drainage, especially in complex cases or if more procedures are anticipated.
- Extracted stones are sent to a laboratory for analysis to identify composition, which informs prevention strategies.
| Step | Description |
|---|---|
| Imaging | CT, X-ray, ultrasound to locate stones and guide access |
| Access | Needle placement to urine-collecting chamber |
| Sheath Insertion | Tube placed for instrument passage |
| Stone Removal | Breaking and extraction of stones; fragments removed |
| Nephrostomy tube | Drainage tube may be left in place during recovery |
After the Procedure: Hospital Stay, Recovery, and Follow-up
Following PCNL, hospital observation is common—typically ranging from 1-2 days, depending on the patient’s condition and the complexity of the surgery.
Immediate Postoperative Care
- Vital signs monitored for bleeding and infection
- Drainage tube (nephrostomy) care: patients are taught to monitor for excessive or abnormal bleeding, including thick or clot-like blood in urine or drainage bags
- Pain management: prescription pain relievers are typically used for a few days
- Activity restrictions: avoid heavy lifting, pushing, or pulling for 2 to 4 weeks
Signs You Should Contact Your Doctor
- Fever or chills (potential sign of infection)
- Persistent or severe pain not relieved by medication
- Bleeding in urine or drainage tube
- Difficulty with urination
Laboratory Analysis and Long-Term Stone Prevention
Stone fragments removed during PCNL are routinely sent to a laboratory for composition analysis. Understanding the type of kidney stone is essential for:
- Identifying dietary or metabolic risk factors
- Tailoring prevention strategies to reduce recurrence
Your doctor may recommend further evaluation, dietary changes, or medications to prevent future stones.
Expertise and Care at Mayo Clinic
Mayo Clinic is recognized for its extensive experience and leadership in kidney stone treatment and PCNL:
- Specialization: Mayo’s urologists and interventional radiologists have additional training, often seeing only kidney stone patients.
- Team Approach: Multidisciplinary care enables rapid diagnosis and treatment, often combining evaluation and corrective surgery in short succession.
- Research: Ongoing studies improve diagnosis, technique, and outcomes for kidney stone procedures.
- National Recognition: Mayo Clinic consistently ranks among top hospitals for urology and cancer treatment.
Frequently Asked Questions (FAQs) about Percutaneous Nephrolithotomy
Q: Who is a candidate for percutaneous nephrolithotomy?
A: Candidates are typically those with kidney stones larger than 2 cm, staghorn calculi, or stones that cannot be treated with less invasive methods.
Q: Will I need a hospital stay after PCNL?
A: Yes, most patients remain hospitalized for 1 to 2 days post-procedure for monitoring and recovery.
Q: Is PCNL painful?
A: The procedure itself is not painful due to general anesthesia. Mild to moderate discomfort is common during recovery and managed with medication.
Q: How soon can I return to daily activities or work?
A: Patients often resume light activities after one week but should avoid heavy lifting or strenuous activity for 2 to 4 weeks.
Q: Are there ways to prevent kidney stones after PCNL?
A: Yes. Preventive strategies depend on stone composition and may include dietary modifications, hydration, and possibly medication.
Q: What happens if some stone fragments remain?
A: Additional procedures may be planned if fragments remain, especially if symptomatic or at risk for causing future issues.
Key Points for Patients and Caregivers
- PCNL is a safe, effective option for removing large or complex kidney stones.
- Be aware of risks (bleeding, infection, injury) and follow postoperative instructions closely.
- Hospital stay is usually brief; recovery typically requires several weeks of avoiding strenuous activity.
- Laboratory analysis of removed stones aids in prevention of future kidney stones.
- Mayo Clinic offers specialized, high-volume PCNL care backed by research and multidisciplinary expertise.
Conclusion
Percutaneous nephrolithotomy represents a vital surgical solution for patients facing large, complex, or treatment-resistant kidney stones. By combining imaging guidance, minimally invasive access, and advanced expertise, PCNL improves patient outcomes and supports long-term health goals for individuals at risk of kidney stone recurrence.
References
- https://www.augustahealth.com/procedure/percutaneous-nephrolithotomy/
- https://www.mayoclinic.org/tests-procedures/percutaneous-nephrolithotomy/about/pac-20385051
- https://www.mayoclinic.org/tests-procedures/percutaneous-nephrolithotomy/care-at-mayo-clinic/pcc-20385053
- https://www.mayo.edu/research/clinical-trials/diseases-conditions/kidney-stones
- https://www.mayoclinichealthsystem.org/locations/fairmont/services-and-treatments/urology/urologic-conditions-and-treatments/kidney-stones
- https://www.mayoclinic.org/diseases-conditions/kidney-stones/care-at-mayo-clinic/mac-20355761
- https://www.mayoclinic.org/tests-procedures/percutaneous-nephrolithotomy/doctors-departments/pdc-20385052
- https://www.mayo.edu/research/clinical-trials/tests-procedures/percutaneous-nephrolithotomy
- https://www.mayoclinichealthsystem.org/locations/new-prague/services-and-treatments/urology/urologic-conditions-and-treatments/kidney-stones
Similar Articles
Read full bio of medha deb
