What is PCNL, and when is it recommended?

PCNL (Percutaneous Nephrolithotomy) is a minimally invasive procedure to remove large or complex kidney stones. It is typically recommended for stones too large to pass naturally or be treated with other methods like shock wave lithotripsy.

What are the benefits of PCNL over other procedures?

PCNL is effective for large or irregular stones, reducing the need for multiple procedures. It is also less invasive than open surgery, leading to quicker recovery times and a lower risk of complications.

Patients are under anesthesia during the procedure, so there is no pain. Some discomfort or soreness in the back may be felt post-operatively, but this is usually managed with pain medication.

Are there any risks associated with PCNL?

As with any surgical procedure, risks include infection, bleeding, or injury to surrounding organs. Your healthcare provider will discuss these risks and ensure you are an appropriate candidate for PCNL.

Can kidney stones recur after PCNL?

Kidney stones can recur if preventive measures aren’t followed. Staying hydrated, following dietary recommendations, and attending follow-up appointments are critical steps to reducing recurrence.

What are the benefits of PCNL over other stone removal methods?

PCNL is particularly effective for removing larger stones or stones that cannot be treated with non-invasive methods. Compared to open surgery, PCNL requires smaller incisions, typically resulting in less pain, shorter recovery time, and fewer complications.

Are there any restrictions after the procedure?

After PCNL, you may be advised to avoid strenuous activity or heavy lifting for several weeks. Drinking plenty of fluids will help flush out any remaining stone fragments. Your doctor will give you specific diet and activity restrictions and guidelines during recovery.

How will I know if all the stones have been removed?

Following the procedure, imaging tests such as X-rays, ultrasounds, or CT scans may be used to ensure all the stones have been removed or broken up. Your doctor will review the results and inform you if further treatment is needed.

Is PCNL the only treatment option for kidney stones?

PCNL is typically used for large kidney stones or stones that cannot be treated with other methods, such as shock wave lithotripsy (SWL) or ureteroscopy. For smaller stones, less invasive treatments may be recommended. Your doctor will choose the best treatment based on your stones' size, type, and location.

What is the success rate of PCNL?

PCNL is a highly effective treatment for large kidney stones, with a success rate of approximately 85-95%. The success rate can depend on factors such as the size, location, and number of stones, as well as the patient's overall health.

Can kidney stones come back after PCNL?

Although PCNL is an effective treatment for removing kidney stones, new stones could form in the future, primarily if the underlying causes (such as dehydration or dietary factors) are not addressed. Your doctor may recommend lifestyle changes to help prevent recurrence.

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Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is a surgical procedure to remove kidney stones that are too large to transit typically. Due to the crystallization of chemical compounds in the urine, kidney stones form in the urinary tract. Percutaneous nephrolithotomy (PCNL) is typically recommended when other methods to pass a kidney stone are ineffectual or impossible.

The term "percutaneous" indicates that the procedure is performed via the epidermis. The term "nephrolithotomy" refers to the excision of a calculus (kidney stone) from a kidney.

Why is it done?

Percutaneous nephrolithotomy is often advised when:

Large kidney stones obstruct more than one branch of the kidney's collecting system. These are known as staghorn kidney stones.
Kidney stones are more significant than 0.2 centimetres (0.8 inches) in diameter.
The ureter connecting the kidney to the bladder contains large stones.
Alternative treatments have failed.

The surgery

This procedure has been performed on many patients over the last several years and is the accepted standard of care for patients with large, very firm, or resistant kidney stones. As a result, it has replaced traditional kidney stone operations for most patients.

Surgical procedures typically last between three and four hours. To conduct the surgery, a 1 cm incision is made in the back or side of the patient. A catheter is inserted into the kidney through the incision under x-ray guidance. The stone is broken up and discarded. Before the stone can be extracted, a laser or a lithotripter may be used to split it up, if necessary. Compared to open stone surgery, this procedure has resulted in substantially less post-operative pain, shorter hospital stays, and an earlier return to work and daily activities. This method has a higher success rate for removing all stones in a single session than other methods, such as extracorporeal shock wave lithotripsy (ESWL), which frequently requires multiple attempts.

Risks and complications

Although this procedure has been demonstrated to be highly safe, as with any surgical procedure, there are potential risks and complications. The rates of safety and complications are comparable to those of open surgery. Possible dangers include:

Blood loss: There will be some blood loss during this procedure, but patients rarely require a blood transfusion.
Infection: Antibiotics with a broad spectrum are administered to all patients to reduce disease risk after surgery.
Tissue/Organ Damage: Although uncommon, damage to adjacent tissue/organs such as the intestine, vascular structures, spleen, liver, lung, pancreas, and gallbladder may necessitate additional surgery. Loss of kidney function is uncommon but a possible risk. Additionally, scar tissue may form in the kidney or ureter, necessitating further surgery.
Conversion to open surgery: If complications arise during this surgical procedure, it may be necessary to convert to an available operation. This may necessitate a larger standard open incision and a prolonged recuperation period.
Failure to Remove the Stone: It is possible that the stone(s) cannot be removed entirely, typically due to the size or location of the stone(s). Additional care may be necessary.

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Percutaneous Nephrolithotomy (PCNL)

The term "percutaneous" indicates that the procedure is performed via the epidermis. The term "nephrolithotomy" refers to the excision of a calculus (kidney stone) from a kidney.

Why is it done?

Percutaneous nephrolithotomy is often advised when:

Large kidney stones obstruct more than one branch of the kidney's collecting system. These are known as staghorn kidney stones.

Kidney stones are more significant than 0.2 centimetres (0.8 inches) in diameter.

The ureter connecting the kidney to the bladder contains large stones.

Alternative treatments have failed.

The surgery

Risks and complications

Blood loss: There will be some blood loss during this procedure, but patients rarely require a blood transfusion.

Infection: Antibiotics with a broad spectrum are administered to all patients to reduce disease risk after surgery.

Tissue/Organ Damage: Although uncommon, damage to adjacent tissue/organs such as the intestine, vascular structures, spleen, liver, lung, pancreas, and gallbladder may necessitate additional surgery. Loss of kidney function is uncommon but a possible risk. Additionally, scar tissue may form in the kidney or ureter, necessitating further surgery.

Conversion to open surgery: If complications arise during this surgical procedure, it may be necessary to convert to an available operation. This may necessitate a larger standard open incision and a prolonged recuperation period.

Failure to Remove the Stone: It is possible that the stone(s) cannot be removed entirely, typically due to the size or location of the stone(s). Additional care may be necessary.