Percutaneous Nephrolithotomy (PCNL)

PCNL is percutaneous nephrolithotomy.

It is a standard of care surgery for large stones

or complex kidney stones.

Your surgeon will get access directly into the kidney

through your back or your flank using a needle.

There are different ways that we can do this using

x-ray or ultrasound.

Occasionally, some urologists may have interventional

radiologists help with getting access maybe the morning of

or a day or two prior,

and you may have a tube coming out

of your back leading up to surgery.

Once access is obtained into the kidney,

the track is dilated, not very much, just a four millimeters

or one centimeter, depending on if it’s a mini perk

or a standard perk,

and instruments are put into the

kidney directly through that tract.

You have a sheath in there to protect it,

and through those instruments, we’re able

to break up the stones using litho, TERs or lasers

and actually remove the stones and suck them out.

The procedure time depends on the stone burden,

anywhere from about an hour to two or three hours.

It is possible with a very large stone burden

that you may need more than one tract into the kidney

and afterwards you’ll have some tube for drainage.

Most likely. Some people leave a ureteral stent in place

for about a week or so

after other providers may leave a tube hanging

out of the kidney, down the back.

The removal of those drains really depends on the provider

and on a case by case basis.

These procedures may be done on an outpatient basis.

Some providers keep the patients overnight.

Some providers get a CT scan the next morning to look

for residual stones.

This is probably the most invasive procedure that we do

for stones or one of the main risk being bleeding

because we go through the kidney.

There is a risk of bleeding, requiring blood transfusion.

Other risks include infection with a risk of sepsis,

the risk associated with general anesthesia, risk

of residual stones needing a secondary procedure

or the risk of a severe injury to the ureter,

which is very, very rare.

Also rare would be the risk

of a injury to a surrounding organ.

Your liver, if it’s your right side, your spleen,

if it’s your left, your bowel, your lung, et cetera.

A lot of providers using ultrasound to get access,

we can see all of those sub all

of those objects in real time

and we’re able to avoid them appropriately.