Percutaneous Nephrolithotomy (PCNL)

What does this procedure involve?

This involves puncturing your kidney through the skin of your back or side with a needle (using X-ray or ultrasound to guide the puncture) and stretching up a track into the kidney through which a telescope can be passed. We may need to puncture the kidney at more than one site to reach all your stone(s).

We then fragment the stone(s) in your kidney using a laser, lithoclast (mechanical fragmenter) or ultrasound probe. We may leave a drainage tube in your kidney (nephrostomy) or an internal tube (ureteric stent) at the end of the procedure and we usually put a catheter in your bladder.

Key points

• The aim of this procedure is to fragment stones in the kidney telescopically using a “keyhole” approach to your kidney through a puncture in the skin of your back
• It is a major procedure and is usually reserved for larger stones or for patients with complex kidney anatomy
• We puncture the kidney with a needle, under ultrasound or X-ray guidance, and stretch up a “track” into the kidney through which we can pass a telescope
• The stone is broken up using a laser fibre, a lithoclast (small pneumatic drill) or an ultrasonic suction probe
• This procedure has largely eliminated the need for open surgery to remove kidney stones, because there is a similar stone clearance rate and recovery is much faster
• The procedure takes 1-3 hours to complete, depending on the size of your stone(s)
• You can expect to be in hospital for one to three days but, in some patients, the operaton may be done as a day-case procedure