Percutaneous nephrolithotomy (PCNL)

Keyhole surgery for kidney stone removal

PCNL is an alternative option when other procedures like extracorporeal shock wave lithotripsy (ESWL) are not possible

About PCNL

Percutaneous nephrolithotomy is typically recommended when other procedures like extracorporeal shock wave lithotripsy (ESWL) are not possible. In ESWL, ultrasound shock waves break the stone into tiny fragments that can then be passed naturally when you urinate. The PCNL technique allows the removal of a large amount of stones in a single operation.

Need to know

  • What happens icon plus

    Percutaneous means through the skin and nephrolithotomy means taking stones out of the kidney. It takes one to two hours and is carried out under general anaesthetic.

    Using X-ray guidance, a radiologist passes a surgical telescope (nephroscope) through a small cut in the skin into the kidney to see your stone. The stone is broken into fragments and removed via the nephroscope.

    A drain called a nephrostomy tube may be left in the kidney. A fine tube or stent that goes from the kidney down the ureter and into the bladder may also be inserted. The fluid that comes out is initially blood stained but clears in one to two days. A urinary catheter is inserted after the operation.
  • How to prepare icon plus

    You'll need to attend a pre-op assessment to ensure that you are fit enough to undergo surgery. Bring a list of your regular medications with you. You may have blood tests as well as other investigations such as a urine test, electrocardiogram (ECG) or chest X-ray to this appointment.

    If you take blood thinning medication, you may need to come into hospital a few days before surgery or switch the you rtablets to an injection for a few days before you are admitted. You'll be receive advise on the best approach.

    If you smoke, you may be asked to stop smoking, as this increases the risk of developing a chest infection or deep vein thrombosis (DVT). Smoking can also delay wound healing.
  • Afterwards icon plus

    You'll wake up in the recovery room of the operating theatre before being taken back to your floor. You'll have intravenous fluids (a drip) at first but you should be drinking and eating normally the next day.

    The urinary catheter is usually removed with the ureteric tube the morning after surgery. The small nephrostomy tube coming directly out of the kidney also drains urine. An X-ray dye will be injected down this tube on the third post-operative day and if the kidney is draining well, the tube will be removed.

    If the X-ray shows that this is not the case, you'll be discharged with the drain in place. A repeat X-ray will be booked a week later.

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This content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
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