Percutaneous Nephrolithotomy (PCNL)

1. What is PCNL?

Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large or complex kidney stones. It involves making a small incision in the back to access the kidney directly and remove or break up the stones using specialized instruments.

2. When is PCNL recommended?

PCNL is usually recommended for:

  • Large kidney stones (typically over 2 cm)

  • Multiple stones or staghorn calculi (stones that fill much of the kidney)

  • Stones that have not responded to other treatments like ESWL or ureteroscopy

  • Infected or obstructive stones causing serious symptoms

3. How is the PCNL procedure performed?

  • The patient is placed under general anesthesia

  • A small incision is made in the lower back

  • A hollow tube is inserted into the kidney under imaging guidance

  • Through this tube, instruments are used to break and remove the stones

  • Sometimes a nephrostomy tube or temporary stent is left in place to aid drainage and healing

The procedure typically lasts 1–3 hours, depending on the stone burden.

4. What is recovery like after PCNL?

  • Most patients stay in the hospital for 1–2 days

  • You may feel mild soreness at the incision site

  • A nephrostomy tube (if placed) is typically removed after a few days

  • Most patients can return to light activity in about 1–2 weeks

  • Full recovery is expected in 2–4 weeks, depending on individual factors

5. What are the risks or side effects of PCNL?

While PCNL is safe and effective, potential risks include:

  • Bleeding, possibly requiring transfusion

  • Infection or fever

  • Injury to surrounding organs (rare)

  • Urine leakage or delayed drainage

  • Need for additional procedures if stones remain

Your urologist will take steps to minimize these risks and discuss them with you in advance.

6. How effective is PCNL?

PCNL is considered the gold standard for treating large or complex kidney stones, with high success rates and a low recurrence rate when paired with follow-up care and prevention strategies.

7. Will I need follow-up after PCNL?

Yes. After PCNL, follow-up includes:

  • Imaging (X-ray or CT scan) to check for any remaining stones

  • Possible removal of nephrostomy tube or stent

  • Stone analysis to determine the cause

  • Preventive care to reduce risk of future stones