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 tend to cause blockage, pain and kidney damage. Shockwave treatment (ESWL) is not suitable because such big stones are not only harder to break, but can also cause further blockage of the kidney when they pass down the ureter.

Prior to surgery, a ureteric catheter is passed up into the kidney via a cystoscope. Radio-opaque dye is then injected to provide a "road map" picture of the kidney system to plan the best approach for the puncture track. The track is enlarged using serial dilators so that a large nephroscope can be inserted. Through this nephroscope, an ultrasonic or pneumatic probe is used to break the stones and remove the broken stone 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 assess for any sizeable residual stone fragments as a completion session should be done before removing this tube. Alternatively, any sizeable remnant stone can be broken by ESWL at a later date. After removal of this nephrostomy tube, leakage of urine can be expected for 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 should not exceed 2 weeks. About 3% may need readmission to hospital for urgent radiological intervention if excess bleeding occurs as a result of 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 within a few days after removing the nephrostomy tube.