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Percutaneous nephrolithotomy

PCNL is an operation to remove large kidney stones.  It is performed through a small incision in the back over the kidney and creation of a tunnel into the kidney allowing the passage of a urological operating telescope (nephroscope).  The nephroscope has a light and camera allowing good visualisation into the kidney, along with irrigation with water.  Instruments can be passed in and out to break up stones and remove stone pieces.

The procedure is performed under general anaesthetic and lasts between 1 and 3 hours depending upon the complexity of the surgery and the volume of stone present.

The risks of the procedure are not insignificant.  These include heavy bleeding from the kidney, which is not very common, infection, and more rarely damage to adjacent organs including liver, spleen, lung or bowel (generally very uncommon).  Other risks include leakage of urine after the procedure, loss of stone fragments down the ureter tube which can cause pain, infection in the blood stream or sepsis, and failure to remove all stone in one operation thereby requiring a second or even third procedure in some patients.

The recovery is generally fairly rapid and patients can generally be discharged on the first or second day after surgery.  After the operation a drainage tube is left in the kidney overnight and this is usually removed the following day if there are no issues.  Sometimes a ureteric stent is also placed in the ureter tube between the kidney and the bladder if deemed necessary by the surgeon to allow drainage and passage of small fragments.  After discharge from hospital patients are seen again in a few weeks’ time usually with further imaging in the form of a CT or x-ray to assess if there are any stone fragments left.  Small remaining fragments can usually be treated by working from inside the ureter and kidney by using flexible pyeloscopy and laser.