What Is Percutaneous Nephrolithotomy (PCNL)?

If you have larger kidney stones or if other methods for stone removal have not worked, such as extracorporeal shock wave lithotripsy, then your doctor may recommend a percutaneous nephrolithotomy procedure. 

It is a minimally invasive surgery with low risk. Still, your safety is our priority. All the doctors at Urology of Greater Atlanta are board-certified urologists and expertly trained to perform this procedure. 

We operate in multiple locations throughout Georgia. Contact us today to book an appointment!

What Is the PCNL Procedure?

Percutaneous nephrolithotomy is a minimally invasive procedure used to remove kidney stones. The word percutaneous means through the skin, and nephrolithotomy refers to kidney stone removal.

How Does Percutaneous Nephrolithotomy Work?

Your surgeon will begin by making a small incision in your back of 1 cm or less. They will then insert a protective sleeve to reach the kidney. Through this sleeve, they will insert the miniature tools needed to remove the kidney stones.

Once your surgeon has access to your kidney, they can identify where the kidney stones are using a nephroscope, which is a small fiber-optic camera. They may then use a shock wave device to break down large kidney stones. Your surgeon will then remove all the kidney stones through the small incision in your back.

What to Expect During PCNL Surgery?

You will be under general anesthesia during the percutaneous nephrolithotomy procedure, so you won’t be aware of what is going on during the procedure, and you will not feel any pain. You will be in the operating room for approximately three hours. 

Then you will be transferred to the ward from the recovery room after the anesthesia has worn off.

The surgeon will insert a ureteral stent into your urinary tract during the procedure to prevent postoperative pain in the flank area. This stent will be seen coming out of the urethra, along with a drainage tube from the bladder. 

The surgeon will also have a third drain coming from the back incision called a nephrostomy tube. Its purpose is to drain urine from the kidney. On the second day after surgery, all three drains are removed, and patients can usually go home. 

You will be given pain medication and antibiotics before you are discharged. You can expect to experience a variable level of postoperative pain.

One week later, you will need to return to the clinic to remove the sutures of the back incision. Two weeks following surgery, you can expect the post-operative pain to disappear. Once the back suture is removed, you can usually return to work.

Who Is a Candidate for Percutaneous Nephrolithotomy?

If you have a kidney stone larger than 1.5 cm, then you will be a good candidate for PCNL. It is by far the most effective procedure to remove large stones.

Advantages and Risks of a PCNL Procedure

The main advantage of the PCNL procedure is that it will remove kidney stones that cannot be passed with other methods. Also, as the surgery is minimally invasive, you will heal quicker than with open surgery.

Even with minimally invasive surgeries, there are some risks involved. Listed below are some of the risks associated with the PCNL surgical procedure.

• Anesthesia risks
• Blood clots
• Kidney damage
• Healing problems
• Infection
• Mass of clotted blood (hematoma)
• Inability to remove the kidney stone
• Fluid buildup at surgical sites (seroma)
• Sepsis or a complicated urinary tract infection
• Need for further surgery