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.

19 Responses to Percutaneous nephrolithotripsy

  1. Diane says:

    I cannot wait until I see my Dr in Jan. My stone is causing me such pain. Bring the PCNL! Let’s do this!!!

  2. Lucy Webster says:

    I had CT scan after being admitted to hospital with sickness and kidney pain. I have 5cm staghorn and I am seeing consultant later today. I have a stent in and find it very uncomfortable and keen to have it removed. I was wondering if there is approximate time from diagnosis to removal of stone as PCNL operation please?
    Emma

  3. Diane says:

    I have a 2.5 cm stone and hopefully this is the way I’m headed. This is a repeat of 2007 for me except they tried lithotripsy first and OMG MY STENT PAIN!!! Not to mention nothing was passing and the hypdronephrosis was worsening. I had to have the stent out (best feeling ever!), a nephrostomy tube inserted, and then 2 PCNL (because he missed the stone the first time). I don’t want a stent. I don’t want it. Don’t don’t don’t. It hurts so bad. They’re going to have to sedate me for as long as I have one if they want to put one in. Sounds like we’ve all had troubles. Here’s to praying for us all.

  4. Jane Westerman says:

    Hi Kathy
    I am pleased you are doing really well. I have recently spent 6 days in hospital with lots of pain. I have had numerous different types of scans and xrays and on Tuesday the doctor advised me that the best option would be to remove the kidney, but they would make their final decision after I had had my kidney x ray, which I had Wednesday, however on leaving hospital on Thursday they still did not have the results for that. So looks like I will have to hang on til the 20th when I have my consultant appointment to hear what will be removed, kidney or just stone. I found out after asking one of the doctors who showed my my stone on the ct scan that it was 36.5 mm (3.65 cm) so large for a normal kidney stone but I think about average for a staghorn. I will let you know how I get on, on the 20th. I left hospital with 9 different types of medicines, and two of them are for bladder spasms, and they do help. However I have got yet another infection so am suffering similar problems to the stent as a result of that. Hope you continue to improve. Jane xx

    • Jane Westerman says:

      Hi
      Just to let everyone know I had my PCNL on the 26th November, I was fortunate that the staghorn didn’t do any damage to my kidney, so that was saved. I did however have the staghorn and 3 small stones by the time of surgery. I had my surgery at 08:55 precisely and apparently due to the size of the stone and the location, my consultant said it was very complicated and tricky, so took just short of 5 hours. However despite that I am recovering really well. The following day I had a CT scan to check if all of the stones had been removed and was pleased that the only thing left behind was a very small fragment of one of the stones. On the Saturday they clamped my nephrostomy tube with the view to removing it and then I could go home, but when they did I had the worst pain across my pelvis. They unclamped it and the pain was relieved, this led the consultant to believe that there may have still been a blockage and recommended that I have a stent put in. I had just had the previous stent removed with this PCNL. Still in hospital attached to my nephrostomy tube a week later and they decided to do another ct scan to double check if a stent would be necessary, but the flow from my kidney was working fine, so they decided that a stent would not be needed. However this scan revealed I had two very small stones.( This is what I am now concerned with, I am not worried about the stones themselves as I have been told they are small enough that they should pass on their own, but what worries me is have I developed these stones since the previous scan was taken 6 days before, or could it be just that the previous ct scan missed them? If I have developed new ones, this concerns me how fast I am producing kidney stones. Anyone have any advice about that? I know that I had developed 2 kidney stones from a ct scan I had in September til October when I had my follow up one). After the scan showed that my kidney flow was fine and I would not need a stent, the decision was made to remove the nephrostomy without clamping it first and for me to go home. Apart from a lot of leakage and not enough dressings for the first 2 days, I am healing really well. I do tire very quickly and if I do too much for example I have just stood and done a load of ironing I feel very achey and sore. Also I find that I wake up between 4 and 5 every morning since I have been home aching a lot around the kidney area ( a kind of throbbing pain) and then aches and pains across my back from one shoulder blade to the other, below both ribs, down the full left side where the surgery was, and across my pelvis. The pain is nothing like the stone pain and is managed by pain meds, but it is annoying that it doesn’t let me sleep. Typical when my 1 year old has been with her grandparents all week, so I could get some rest lol. I am now currently waiting a letter for a follow up appointment, so hope I get some answers regarding the other stones then.

  5. meanna says:

    Hi i am having pcnl surgery in a week so nervous !! What is recovery time how long till i can return to work been off work two months so ready to feel better and return to work thanks in advance.

    • Jane Westerman says:

      Hi I am due to have pcnl on the 26th November, by now I should think you will have had your surgery, but just in case I have been advised that it will take 2-4 weeks for a full recovery. I have been off almost 4 months already, so I understand how difficult it is. Good luck x

  6. Joanne Gillen says:

    After 10 weeks of antibiotics,I’ve been told yesterdày I hav a huge staghorn kidney stone ( 10 cm ) omg,doc says 3 to 4 hours in theatre,5 day stay in hospital has anyone had a stone of this size removed ????

    • jane westerman says:

      Hi
      I have just been diagnosed last week as having a huge staghorn stone too, although he didn’t give me the exact measurements. I too have to be admitted to hospital he also told me about 3 hour operation but only told me I would probably be in hospital from about 3 days. I am sorry I haven’t any experience to tell you about it, as in the same boat, but would be grateful too for any information at all. It is a PCNL operation he has recommended. Also I am wondering how long we will wait for the operation, as I have been suffering for years with pain (got told nothing wrong with me just muscular) and just diagnosed this last week currently been on sick from work as pain is unbearable. So the sooner the better for me. Good luck for your operation xxx

      • Kathy says:

        Hi Jane!

        Was wondering if you had your surgery yet? I just got out of hospital (just an overnight) yesterday after having a minimally invasive PCNL for 2×1 cm staghorn stone in right kidney, and utereroscopy on left for two other stones. My story sounds very similar to yours – misdiagnosed for years (not that I didn’t complain!). I had bilateral stents placed also. Incision from PCNL is only 1 cm. They removed the tube when I was discharged and waterproof bandaged it. Incision tends to leak the first couple of days after tube removal. Will not even need it rebandaged if it’s not leaking tomorrow. The nurses kept me very comfortable with pain medication in the hospital. Can honestly say, after pain and infection of stones, the surgery was very bearable. Was walking the hospital floor that night. Am planning on stopping narcotics today. Discomfort from the stents is worse than the incision area – kind of spasms/burning when I urinate- which is frequently. I do tire easily and rest a lot, but can putter around the house for a few hours at a time. Can definitely tell if I am overdoing it. I didn’t know what to expect, but it was much easier than I imagined. Doctor told me two weeks to feel “normal”. Can’t drive for a week or lift anything heavy, but can do almost anything else that is not too strenuous. Already feel better. Don’t know if you are having the minimally invasive type of PCNL, but hope my experience helps you. Good Luck. Know you will ultimately feel MUCH better! The anticipation prior to the surgery was the worst part along with the prepping/clear liquid diet.

      • Kathy says:

        Hi!

        Just an update on my surgery. Did stop narcotics on day three. I was hoping that “fuzzy headed feeling” would go away, but still was kind of “out of it” regardless for another 3-4 days. Am now going on 10 days from operation (PCNL on right and ureteroscopy on left). Had right stent removed a week out which was very non eventful. There are some real horror stories pertaining to the stent removal and I was very scared, but really had no problem – that side feels much better already. Remaining stent is still making me mildly miserable with frequent urination and cramping the most annoying problems. – Feels similar to bad menstrual cramps. Still tire easily and nap often. Am taking Aleve alternating with Tylenol as recommended by urologist. Went shopping yesterday and out to lunch with friend, had to take a nap on return. Would advise not to overdo it and listen to your body. I am fortunate in that I am not currently working. I would try to take at least 2 weeks off if possible, and if not, reduce your work load considerably. The heating pad was my best friend for the first 5 days. Had it on low and used it every time I lay down. Hope my experience alleviates some of the fear. I went into it completely mortified. I won’t sugar coat it, it’s not a vacation, but very doable. Just don’t be afraid to use the pain meds as needed and take it easy.

        • Jane Westerman says:

          Hi Kathy

          Thank you so much for your reply it is most helpful, I am sorry I have taken so long to read this until now. You have done brilliantly I cannot believe you were only in overnight. I have been told to expect about a three day stay, they haven’t mentioned anything whether it is minimally invasive or not though, gave me a leaflet on it. I went to see a new consultant as previous one was a nightmare, he even sent paperwork to GP to say my staghorn was on the right, which is incorrect as it is on the left. Anyway new consultant advised I have a huge staghorn (still do not know how huge I keep forgetting to ask how big) and it has completely blocked my ureter. He admitted me immediately to have a stent fitted as he said that the PCNL op waiting list is 2-3 months. After having stent fitted I bled really heavily for about 3 days, which I was told was normal as it was a brutal procedure, I only expected bleeding whilst urinating and not constantly. Anyway other than the discomfort you are talking about, I have to say it hasn’t been too bad. The good news is despite consultant saying about the long waiting list for PCNL he has decided I shouldn’t wait much longer as he is very concerned about my kidney and he has booked me in for a kidney xray on the 5th November to see if it is functioning, and then I have a consultation with him on the 20th November to discuss the results (presumably) then he has pushed me up the queue and I am to have PCNL on the 26th November. So not as long to wait. They haven’t mentioned removing stent yet, so I am wondering if they will do that when I have the PCNL. I also have a small stone which they haven’t mentioned removal of. I have a lot of questions at my consultation. I am so pleased you have recovered quickly and hope they do not re-occur. Work do not want me to go back until all my treatment is finished, as it is pointless to go back and keep being off all the time. So going to make the most of it and take a few weeks off hopefully after my op and hoping to go back in the New Year as do not see the point in going back round Christmas time, so I may drag it out a bit lol. I have been off this long so may as well go back when it suits me. x

          • Kathy Boyle says:

            Hi Jane!

            Your situation sounds a bit more severe than mine. I had no obstructions. My guess is that you will be keeping that stent even after the procedure. Did they give you a Flomax Rx? I thought it really helped with the stent. I kept my right stent for a week after PCNL and two weeks for the left ureteroscopy (Dr. said he did “quite a bit of work there” which translates “you will be a little raw down there so we should keep the stent a bit longer”). It does get easier as you have probably found out. I have read many people go home with the nephrostomy tube also – let’s hope you are one of the lucky ones and get it out at the hospital. I hope your kidney function is still good and glad you don’t have to work! And yes, the stent is brutal! I was originally scheduled to have the two procedures 4 days apart, but Dr. found “something” on CT scan and they postponed PCNL. I was already prepped for surgery, so they placed other stent in left before stone removal on that side. Ended up with renal colic that evening. Hubby was beside himself seeing me in that much pain – glad I had the oxycodone Rx. I just didn’t take it soon enough. Got to go for another CT scan with contrast dye to check out right side issue – it was a “nothing”. So, I got a little scare over the weekend. Re-prepped for both surgeries and had both together. Doesn’t sound like you are going to get the option of the minimally invasive surgery. Your stone sounds pretty big! Maybe they don’t want to scare you? My Dr. showed me mine on the scan (it was hard to miss!). I went for a walk yesterday and am doing great! I feel 100%. I think the infection was kind of insidious and really wearing me down. They had me on numerous and copious amounts of antibiotics. My thoughts are with you. Had my follow up ultrasound today and last (?) appointment with Dr. tomorrow. Am drinking a lot of water and watching my diet (had calcium oxalate stones on left). Please let me know how it goes. Am thinking of you.

  7. Katie says:

    I have been advised two different types of treatment from two different urologist and am unsure of which is best.

    1- remove kidney

    2- PCNL

    My right kidney is dramatically smaller than my left. The right kidney function is 17% with a complete stag horn stone 4cm+. The left is healthy except for a 1cm stone inside the kidney tissue.

    They have advised the PCNL will take 3 different surgeries to complete. Which sounds a bit daunting.

    Any insight would be greatly appreciated. Thank you!

  8. Geedee says:

    Hi can anyone share with me recovery time after a PCNL (hopefully please without a second stent !) I read it is 3 or so days in hospital a week recovery and full recovered in two weeks … I’m due a pcnl on 4th June, is it safe to go on holiday (Europe flight) 16th?? Any views appreciated. Ps had this stent for 7 weeks no respite from pain ! And now peeing random blood clots !

    • maryann ferns says:

      I’ve had numerous stents over the last 35 years and my best advise for stent discomfort is to keep something in the bladder. Always be drinking something. In an empty bladder the stent ends rub the walls of the bladder but having liquid in there causes them to float freely.good luck.

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  10. Sudhir kute says:

    I hv ben operated under pcnl kideny stone peocedure on 2/5/13. While surgery two times incision done on my back.
    Still today fluid is continue frm my back.
    I want to know why this happens
    Req suggestion
    Regards
    Sudhir kute

    • jane says:

      My very first kidney stone procedure was the Perctaneous one and nothing went to plan to what the leaflet said.My stone was a massive staghorn that filled my kidney and took over 4 hrs to be told they had removed 90% .My stay in hospital ended up being 6 days not 2 ..I didn’t have a clue what was going on and traumatized isn’t the word. When finally removed the tube from my kidney I didn’t know it was like a little umbrella that opened and closed and and that the nurse taking it out couldn’t close it as there was a stone in it preventing it so you can imagine the pain when she pulled it out still open! I was told to get dressed and when I did I felt warm liquid flood out my incision and panicked and pressed my buzzer for the nurse. She calmly said “oh that’s your wee because it will go to the nearest hole so I,ll just get you a stomer bag!!! WTF???? No one told me I,d need one of these or that I,d be using them at home for 9 days until my incision closed??? Trying to empty them when they are behind well..hard..thats an understatement. I had to get my son to help when he was there or if on my own empty them into my bathroom sink and bleach after as they are so high up you had to be a contortionist to attempt without spilling it all over. I hope no one ever has to endure what I went through and to this day I still suffer from kidney stones and have yearly ops to try and remove them but they keep on coming back!

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