Percutaneous Nephrolithotomy (PCNL)

What is PCNL?

PCNL treats large kidney stones through a tract roughly a centimeter wide created in the back. A scope is passed directly into the kidney, and the stone is broken up and removed. Mini-PCNL uses an even smaller tract for selected stones, and supine positioning is used when it suits the anatomy.

Who may benefit?

• Patients with kidney stones larger than roughly two centimeters.
• Patients with staghorn or branched stones.
• Patients with hard stones that resist laser or shock wave treatment.
• Patients with anatomy that makes scope-based access difficult.

How is the procedure performed?

Under general anesthesia, imaging guides needle access into the correct part of the kidney, the tract is dilated, and the stone is fragmented and removed. Most patients stay one night. A nephrostomy tube or stent may be left temporarily.

What are the benefits?

• The highest stone-free rate of any treatment for large stones.
• Often clears in one procedure what would take several ureteroscopies.
• Improves kidney function outcomes in obstructing stone disease.

What are the alternatives?

Staged ureteroscopy, shock wave lithotripsy for selected stones, or observation for asymptomatic non-obstructing stones.

What are the risks?

• Bleeding, which occasionally requires transfusion or an embolization procedure.
• Infection or sepsis, which is why pre-operative urine cultures matter.
• Injury to adjacent structures, which is uncommon.
• Residual fragments requiring a secondary procedure.

What should I expect before surgery?

• A pre-operative visit to review your history, medications, and goals.
• Instructions on blood thinners, supplements, and diabetes medications.
• A urine culture so any infection is treated before the procedure.
• Nothing to eat or drink after midnight unless told otherwise.
• A responsible adult to drive you home on the day of surgery.

Will I have a tube?

You may wake with a nephrostomy tube in the flank, a ureteral stent, or both, and sometimes a catheter in the urethra. These are removed within days depending on how the procedure went.

What should I expect during recovery?

• Flank soreness for one to two weeks.
• Blood-tinged urine for several days.
• No heavy lifting for two weeks.
• Follow-up imaging to confirm clearance, plus stone analysis and prevention planning.

When should I call the office?

• Fever above 101.5°F or shaking chills.
• Inability to urinate, or a catheter that stops draining.
• Heavy bleeding, or clots that do not clear with increased fluids.
• Pain that is not controlled by your prescribed medication.
• Redness, swelling, or drainage at an incision site.