Percutaneous nephrolithotripsy

Diagram of PCNL

Percutaneous stone surgery is usually used for larger stones. A small hollow tube is placed directly through a patient’s back into the kidney through which larger instruments can then be used to fragment and extract the stone(s). Although this approach typically requires a hospital stay and is more invasive than ureteroscopy or extracorporeal shockwave lithotripsy, it is often the most effective method for treating  large stones quickly and completely. For more information on comparing the surgical options for kidney stones, see our comparison chart.

Percutaneous stone surgery may also be indicated in certain situations where the ureter below a  kidney is obstructed, such as in ureteropelvic junction obstructions, where a ureteroscope cannot be advanced from below.

Fast facts about percutaneous nephrolithotripsy:

  • Typical operative time: 1-2 hours
  • Usual hospital stay: 1-2 days
  • Average number of days before going back to work: about one week
  • Average number of days before feeling back to normal: about two weeks

PCNL instruments photo

A photograph showing a nephroscope used for percutaneous nephrolithotripsy. The gray tube around the instrument is the sheath placed temporarily into a kidney to allow access. A pen is shown for size comparison.

 

 

Video of percutaneous nephrolithotripsy procedure.

 

 

Video of percutaneous nephrolithotripsy procedure of a soft matrix stone. This type of stone is rare and primarily composed of  soft tissue elements. It is usually associated with infection.

58 Responses to Percutaneous nephrolithotripsy

  1. Stoner says:

    Hello,
    I just had PCNL a little over a week ago and I consulted this site numerous times not quite finding what I wanted to know so here is my story for others in the same predicament. I had one “Golf ball” (2.5 cm) stone and 2 small ones in one kidney. I was told PCNL was my ONLY option.
    Since it was a 5-month wait before they could schedule surgery, I used that time to fix my diet (eating lots of fruits and veggies) and lose 25 pounds. I had constant UTIs prior to surgery during those 5 months and consistently stayed on antibiotics prior to the surgery, making sure there was no infection on the day of.
    1 week prior, I took mega antibiotics as a preventative treatment. On the day of surgery, everything was pretty quick. They put an IV in my arm, took me to the OR, put me on the table and the next thing I knew I was waking up in recovery. They did not send me to radiology for painful guidewires, as I had read on this site. If that was done, it was all part-and-parcel of what was done in the OR when I was under.
    I woke up in recovery and got some pain meds almost immediately and was taken to my room about an hour later.
    There were NO TUBES left in my back – they closed up everything during the surgery. The surgeon said the incision in my back might leak urine but it never did. They got all 3 stones out and it was uneventful (woohoo!).
    The pain was not bad but the nurses were good about giving me meds anytime I felt any pain and those meds did the trick – I felt fine. The first day I did not leave my bed since there was a catheter. The hospital had free wifi and since I didn’t feel sleepy (and had a noisy roommate who wouldn’t let me sleep even if I had wanted to) I relaxed and read my phone and watched YouTube videos for hours to pass the time.
    Once the catheter came out the next morning, they monitored my urine output (which was pretty bloody) and of course the stent made things very uncomfortable (but not terrible). I walked around as much as possible to help with recovery.
    The next day I went home. I could have gone back to work right away (I do desk work – I certainly could NOT had stood for too long) but I had taken the week off as vacation time so I just made sure to take short walks every day. My urine was bloody for almost a week but by drinking lots of water, it finally cleared up.
    I had pain meds but never used them until I made the mistake of exerting myself too much a week out and somehow moved the stent. Then I was in a lot of pain for 3 days until I finally couldn’t take it anymore and just pulled the stent out myself (I had the tethered kind – with the string – so it was easy to pull out). The relief of getting that thing out can only be expressed as pure joy. I encourage EVERYONE to demand a tethered stent so that if the pain gets too bad, you can just take it out yourself. Trust me on this one.
    Now a week and 4 days out post-surgery and with the stent out, I feel fine. I am still on antibiotics for another week. My fear is that once I’m off the antibiotics the UTIs will return (along with the anguishing pain). I will keep everyone posted.
    I just wanted to tell my long-winded story because there are just so few PCNL stories out there and I was scared to death of this surgery because of all of the BAD stories I read.
    I should note that my surgeon is world-renowned for this surgery – he does 100 PCNLs each year. That is probably key.
    Anyways, if anyone has any questions, I will revisit this site on occasion. I know I searched far and wide to find out anything I could before the surgery and I appreciate those who have told their stories before me to help ease worries.

    • Stoney says:

      Thanks so much for posting your experience. Mine is set for four weeks from now and what upsets me most is the stent experience. 2010 litho, it was in for 2 weeks. I do have a different Dr this time around so hoping that will make a difference. I’m gonna ask for the tethered this time. Dr said it would stay for 3 weeks..YIKES! This is the first PCNL for me and I’m dreading it for sure. Again, thanks for sharing.

      • Stoner says:

        Good luck to you. 3 weeks with the stent seems excessive. Basically the only pain I felt from the PCNL was caused by the stent and I only had it in for 8 days.. Hopefully they will give you the tethered kind. I’ve had both kinds and the tethered one seems to use softer plastic and is more comfortable by far.
        Plus on 2 occassions now I have taken out the stent myself. Pure physics will tell you that taking it out yourself while standing in a hot shower is much easier on your body than lying horizontally on a table and unecessarily having medical instruments inserted into you to take it out. Honestly, try to convince your physician to let you take it out yourself in a hot shower. Take care.

  2. Trilochan singh says:

    I just gone through this treatment for multiple stones in left kidney with one more than 24mm large from RG Stone Clinic ,pitam pura Delhi India i got a great experience with very skilled Doctors with great care and hospatilaty.Those Doctors were like God to me.THANKS

  3. r. pecego says:

    I went through this surgery two months ago for a1.8 cm non obstructing staggers appetite stone … according to ct scans and many pre operation tests performed by a very busy urology group. The rude and hurried radiology team placed the tube that leads to the kidney at the wrong angle for the surgeon to remove the stone which resulted in a longer operating time and an unsuccessfully attempt at complete removal. Generally the tube is left in over night to see what stones remain and the doctor does a do over. Not for me…just a big cover up of errors and 50,000 dollars later … see you in four months and we order up … beware!!!

    • diane jones says:

      oh Wow, same thing happened to me. Had to go back to hospital two or three times because of leakage from the tube. The pain was incredible. Then when it came time for Dr to put it out, he did it in his office without any anesthesia. I thought someone heard my screams in another country. It was horrendous. He couldn’t do it on the first yang, but the second one it came out.

  4. Robert Hill says:

    I here you. Waking up after ureteroscopy, and having to pee that first time, is like pissing the burning lakes of Hades through your penis. It sucks.

    I’ve got a 9mm stone in my lower right ureter. Doc was unable to get it with ureteroscopy the first time. Wants to try it a second time, end of the month. I am totally dreading this, due to the burning lakes in my penis.

    I have a feeling he’s going to end up going in and surgically removing it eventually.

  5. Ernest Leith says:

    Just went through surgery last night for basic ureteroscopy and (I’ve begged a decade ago to remove the smaller stones, bUT they refused cuz they “may or may not pass”) now I find out after the surgery I have big stones that could not be blasted. I’m so over this stent burning everytime a pee! It’s like pissing lava or razors. Worst part I’d waking up and not falling back asleep due to the shock and pain the pee sends through your body. I can’t imagine a cath. I wish I was born without pain receptors just so I don’t feel pain.

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