IAC (028) 35 11 33 33 Emergency (028) 35 11 35 00 Urology & Andrology Lithotripsy IAC (028) 35 11 33 33 Emergency (028) 35 11 35 00 Urology & Andrology Lithotripsy A modern alternative to open surgery: 90–100% stone clearance through a pin-point incision. What is Percutaneous Nephrolithotomy (PCNL)? Percutaneous nephrolithotomy (PCNL) is a minimally invasive endoscopic procedure used to remove kidney stones. The surgeon creates a small tract (approximately 1 cm) from the flank directly into the kidney. Through this access, an endoscope and stone-fragmenting devices (laser or ultrasound) are introduced to break the stones into small pieces, which are then removed completely. When is PCNL recommended? Large kidney stones (usually larger than 2 cm) Complex staghorn stones filling the renal collecting system Hard stones that have not responded to extracorporeal shock wave lithotripsy (ESWL) Stones causing obstruction, severe pain, infection, or reduced kidney function Key benefits and potential risks Advantages compared to open surgery Less blood loss: Reduced need for blood transfusion Less pain: No large muscle incision in the abdominal wall Better cosmetic outcome: Only a small scar of about 1 cm (versus 10–15 cm with open surgery) Shorter hospital stay: On average 2–3 days (compared to 5–7 days for open surgery) Although PCNL is a highly safe procedure, as with any surgery, certain risks may occur: Risks and complications (rare) Bleeding: Usually self-limiting; vascular intervention is rarely required (less than 0.5%) Infection: Preventive antibiotics are routinely administered; mild fever after surgery can be normal Residual stones: In very complex cases, an additional procedure (ESWL or flexible endoscopy) may be needed to achieve complete stone clearance Injury to surrounding organs: Extremely rare How is the procedure performed? The surgery usually lasts 2 to 4 hours and is carried out under general anaesthesia. 01 Preparation A small catheter is placed from the bladder to the kidney to inject contrast dye, allowing clear visualisation of the collecting system on X-ray imaging. 02 Creating the access tract The patient lies in a prone position. Under ultrasound or X-ray guidance, the surgeon inserts a fine needle into the kidney. This access is gradually dilated to create a safe working channel. 03 Stone fragmentation and removal An endoscope is introduced through the tract. Stones are fragmented using high-power laser energy or ultrasound, and the fragments are removed by grasping or suction. 04 Completion A temporary nephrostomy tube and a ureteric stent (DJ stent) are usually placed to ensure proper urine drainage after surgery. Recovery and home care guidance In hospitalAt home• Patients can usually start gentle mobilisation after one day• The nephrostomy tube is often removed before discharge (after 2–3 days)• Light blood-tinged urine may be observed and is considered normal• Hydration: Drink 2–3 litres of water daily to help flush the urinary tract• Diet: Eat plenty of vegetables and avoid constipation• Activity: Avoid heavy lifting or strenuous activity for the first 4 weeks• Follow-up: After 4 weeks, the DJ stent will be removed during a simple cystoscopic procedure Comparison with other treatment options MethodMain indicationAdvantagesLimitationsPCNLLarge stones, staghorn stones, hard stonesHighest stone-free rate, minimally invasiveRequires general anaesthesia, technically demandingESWLSmall stones (<2 cm), soft stonesNon-invasive, no surgeryLower clearance rate, may require multiple sessionsRIRSUreteric stones, small to medium kidney stonesNatural access, no incisionLimited effectiveness for very large stones, higher equipment costOpen surgery (traditional)Very complex stones, failure of other methodsComplete stone removal in one operationMore pain, larger scar, longer recovery About this Care What is Percutaneous Nephrolithotomy (PCNL)? Key benefits and potential risks How is the procedure performed? Recovery and home care guidance Comparison with other treatment options A major advance in kidney stone treatment nInstead of enduring a 15-cm surgical incision and weeks of pain, PCNL enables complete stone removal through a tiny puncture no larger than the tip of a pen.
