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.

82 Responses to Percutaneous nephrolithotripsy

  1. Donna Brown says:

    I had PNL surgery three weeks ago to remove a 1.3
    x 2.7 cm stone……getting the tube in was very uncomfortable with only some local deadening for the incision. Surgery went well and I went home the next evening, after finally being able to urinate on my own! No tubes were left in to go home with. My incision is almost completely healed but I still have a nagging ache in the same place that hurt before the surgery. I understand there was bruising, etc. just wondering how long before the achy-breaky back feels normal??

    • Jodie says:

      Hi Donna….did you have the actually surgery to remove these stones, or did they break them up and crushed them so you could pass them? I have calcium stones located in the right kidney, one is 7 mm and the other is 3 mm in size. I can not pass them at all, been suffering for over two years with the most horrible pain ever. I had several smaller stones in the left kidney and it took 11 months for me to pass them all….that was something I don’t wish upon my worst enemy! Anyway….the doctor I saw the other day was a scary person to talk to, she was so nervous running all over the place, acting very weird, she would not give me any solid information at all that made me feel I’m having the right procedure done for this issue. First of all, wearing a stent for three weeks is not acceptable to me, and this procedure possibly not working for me, and then having to go back again for another one is scary. She mentioned that I could have kidney damage from this, that’s when I started to do research online to find out more. I’m not sure if those size stones warrant the full surgery to remove them, thats where I’m at a loss? Thanks for any information….

  2. Linda says:

    I had my first Ureteroscope, in July, a SWL on Sept 1and I’m scheduled for a 2nd Ureteroscope this Friday the 22. I have had this stent for 8 weeks and looking at who knows how many more. Back in 2009 I had a PCNL, I don’t remember this kind of pain. I don’t why this was not an option this time. My doctor said the tech said the stone and I were too big for this procedure. I understand I’m over weight, but requiring me to endure a more painful procedure without explaining the reason is not acceptable.

  3. Mike Wroten says:

    I have been diagnosed with a 2.5 cm kidney stone. I had one removed in 2012 (PCNL). My dilemma is I just moved down to Florida from Michigan and apparently not many doctors down here does that surgery. My current doctor has recommended one but I would like to research myself to be sure I am getting one that has a lot of experience, but can’t find a list of doctors that do that surgery. Any suggestions?

    • Donita M Khouri says:

      I just had a pcnl done by Dr. Albert Ong. I also had a pcnl in past. This time it was much better and i did not have complications like before. Dr. Ong was great. I was only in the hospital for 8 hours. No pain at all. I only took tylenol just in case the first nite. This was Friday. I am going back to work tomorrow

  4. Jeanne says:

    I’m scheduled to have this procedure in a few weeks and I’m very scared. Any tips or advise would be appreciated. ?

  5. Swapan Deb says:

    I am from Agartala, Tripura, I have a stone at my right kidny of one cm, l like to remove it by PCNL, what I have to do now, & how l can contact with the SRI SAI HOSPITAL.

  6. Venkat says:

    Hi,

    For my friend4TwO stones are detected in both kidneys. But in left kidney, stone is present here itself only , other side, stone is slipped/ fall down to Below Pipe. Doctor advised to go operation in 2 phases, we are worrying that will repetitive a anesthesia cause any side effects .. could you kindly suggest here

  7. adil says:

    Can any one answer my question.my name is Adil I had 1 cm of stone in my right kidney,was operated well through pcnl mini operate.Also anesthesia was done at that time.stone was broken and partially pieces want to urter,secondly pieces were removed through camera sucking tube.now while removing pieces they injected in spinal cord so it become num.now problem s still sometime pain is there in kidney + in spinal cord where they injected me.can any one guide me about this matter

  8. vic chamley says:

    what is the waiting time after youhave been called back to hospital for a assesment

  9. Abdul Aleem says:

    can any one tell men that can both kidneys be operated( mini pcnl) simultaneously?

  10. Mahalah Perez says:

    I too am having this surgery at Vanderbilt in Nashville next week. My Dr is Nicole Miller and she seems awesome. I have a large staghorn caculi in my right kidney. They say mine is made up of uric acid which is from my diabetes. I’ve been in constant pain since January 16 but Dr Miller was great about getting me into surgery pretty quick. I will pray for each of y’all that your surgery goes well and recovery is a breeze. Keep me in your prayers. My family just lost my grandmother to a heart attack right before Christmas and then I found out about this…my little 6 year old girl is super scared that “mommy is going to go to heaven with her Mawmaw.” I have tried to explain that it is a very easy surgery but the recent loss has been hard on her. So please keep us in your prayers. Thank you. God bless you all!

    • Susi Willis says:

      How did your surgery go? How is your recovery? Thinking of you and in Nashville as well. I found out I have a stag horn stone that will be removed once my colon is healed from the bout of diverticulitis I had over the weekend. It’s how they discovered the stone ;0

  11. 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.

        • Jodie says:

          Hi…thanks for the information, I’m having surgery in the next three weeks, I have a calcium 7m and a 3m stone all in my right kidney, I had asked for the actually surgery to be done to remove them and the doctor said I do not need that. So they will be crushed and a stent used to pass them out. She also wants me to keep the stent in for at least the first week, then an x-ray taken to see if I passed all the stones, if not.. she said another surgical procedure will have to be done. I did not like hearing that at all! I’m very susceptible to urine infections, and I’m worried about getting one wearing the stent for too long, this can effect my healing time and my kidney and make me very sick. I hate this whole mess I’m in, and I’m so worried about kidney damage, which this doctor said could happen…oh my gosh what do I do?

    • Saburina says:

      Thanks for your encouragement. I am scheduled for a week from now. Any other information to share. I am very confident in my doctor. She does these several times a month and I totally trust the hospital. I am going to Vanderbilt in Nashville. She said I would feel like a horse had kicked me in the kidney for about a week. How bad did you feel? I have three in the right kidney only: 9 x 15 stag horn, 7 x 14 stag horn and a 6 in lower portion of kidney. She has scheduled the OR for three hours and has said I would go home the next day. Opinion and Pointers would be appreciated. They said I would feel better once its done but I have felt fine all along. I have an aching pain a lot in my back at my waist at the bottom of my last rib. I also have UTIs a lot. My urine constantly shows bacteria and sometimes blood. When the the UTIs are really bad there is a lot of blood in my urine. I am a little concerned that the stones may be attached because CT scans have shown them for years and this has been going on for years and years and has just kept getting worse. Thanks for your input.

    • Judy says:

      Was there a medical reason or scheduling conflict for the 5 month wait before surgery?

      • Stoner says:

        Judy – The 5 month wait was because I am in a country that has universal health care (I had to pay a bit for a semi-private room, but otherwise everything was free). Also, my surgeon, as I mentioned, is world renowned so he is in constant demand (it was worth the wait).
        Saburina – I too had constant UTIs and now, since the surgery (KNOCK WOOD!) I have not had one UTI. I do have a bit of muscle pain in my back whenever I lift something heavy but I would trade that pain for the UTIs anytime. My pointer to you is to try not to do ANY lifting after the surgery. They say you need to wait 6 weeks, but in my experience (it’s been over 2 months now) I still can’t lift anything heavy without paying for it with a bit of pain. Try to get others to help you with things that involve lifting – I know it’s difficult because you will feel fine otherwise. I’m hoping this muscle pain will eventually heal, but at least it’s not acute (ie not needing to take anything for it).

        • Laura says:

          I’m supposed to go next week. Your posts have given me 100% more information than the doctor did. I have a question about exercising. I’m trying to lose weight, so I’ve been going to the gym and doing yoga (for stress). I don’t lift at the gym, usually just the treadmill. Any idea how long it might take before I’m up to exercising again? Or yoga, which is all sorts of stretching? I’m just worried that if I don’t go for a long time, I’ll get in the habit of not going and stop altogether.

          • Stoner says:

            I waited 6 weeks before doing any kind of exercise (other than a lot of walking, which is an important part of recovery – just stay out of the cold or wear tons of extra clothing). I did 20-minute walks at least twice/day at the beginning. I wouldn’t do Yoga for 6 weeks and then I’d go back to it slowly. I’d wait 3 months before doing any weight training. I’m almost 4 months out now and I can lift things again without fear. Of course everyone is different. This is just the timeline based on my own experience. Good luck with your surgery.

    • Abdul Aleem says:

      thanks alot for your shared story. it gave me encouragement. im going to have bilateral mini pcnl next week. plz pray for me. thanks

    • George says:

      Hello Stoner, i am glad you are better and a success story. Who is the surgeon who did the surgery. If he does 100 a year he must be good. I have a family member who is considering Percutaneous Nephrolithoto (PNL)
      Thank You

  12. 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

  13. 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.

  14. 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.

  15. 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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