Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL)

Watch Video on Percutaneous Nephrolithotomy (PCNL) Operation

This procedure is for removing large kidney stones > 2 cm size using a keyhole approach into the kidney. Such stones are likely to cause obstruction, pain and grow bigger. Shockwave treatment (ESWL) is not suitable because such big stones are not only harder to break, but can also cause blockage of the ureter when the large-volume fragments pass down.

Under general anaesthesia and xray guidance, a catheter is placed into the kidney via the bladder using a cystoscope. Through this tube, xray dye is injected to provide a "road map" picture of the kidney system to plan the best approach for the puncture track. A track is established through a series of dilators to allow a nephroscope to be inserted. Through this nephroscope, an ultrasonic or pneumatic probe is used to break the stones and remove the pieces. At the end of the procedure, a nephrostomy tube is left in the kidney to drain urine, blood and small stone fragments. The nephrostomy tube is removed only after the bleeding has settled. A check xray is done on the 2nd day to look for any significant residual stone fragments. If so, a completion session can be done before removing this tube. Alternatively, this remnant stone can be managed by ESWL. After removal of this tube, leakage of urine can be expected up to 2 days while waiting for the hole in the kidney to close. The operation takes about 2 to 3 hrs and the hospital stay is generally 3 to 4 days. The success rate (defined as residual fragment < 3 mm) for PCNL is > 95%.

Complications include:

  • bloody urine. This is expected to last up to 2 weeks. About 3% may need readmission to hospital for urgent radiological intervention because of excess bleeding from an abnormal artery to vein connection (called a-v malformation).
  • urine leak. This occurs through the puncture wound at the back. However, it should dry up by the 2nd day after removing the nephrostomy tube.