PCNL (percutaneous nephrolithotomy) kidney stone

PCNL (percutaneous nephrolithotomy) surgery

PCNL is a safe surgery to remove kidney stones. It is not open surgery. The word percutaneous means “through the skin”. Therefore, it has less postoperative complications. Further, it removes more stone fragments compared to the alternative ESWL and URS surgeries. The word nephrolithotomy means “Removing stone out of the kidney”.

What is PCNL?

PCNL is a surgical procedure to remove kidney stones. Kidney stone(s) are lodged in the renal pelvis of the kidney, which are formed due to the crystallization of urine compounds. They contain organic components and crystalline. In PCNL surgery, an access track is created in the skin into the kidney without any need for a large open incision. Thus, PCNL is often referred to as “keyhole” surgery.

Percutaneous nephrolithotomy is indicated when an ESWL (extracorporeal shock wave lithotripsy) is not viable or successful to treat fragment kidney stones. In addition, it is performed once the fragmented stones cannot pass out of the urinary system. Other indicators for PCNL include:

Kidney stones are larger than 2cm. However, if the stones are soft and like calcium oxalate, ESWL is still considered.
Hard stones like cysteine kidney stones
Stones that are located towards the lower pole of the kidney
Stones that obstruct ureteropelvic junction
Severe infection

In emergency cases that the stone may cause complete obstruction or severe infection spreading to other parts of the body, percutaneous nephrostomy is done to allow the infected materials to drain from urine and blood. In this case, PCNL is done when the patient is stabilized.

Percutaneous nephrolithotomy procedure

Many patients have gone under PCNL during the last several years, since it is accepted as a gold standard treatment of kidney stones. This surgery has replaced open surgeries for kidney stones removal in the majority of patients. The length of the surgery is totally 3-4 hours. The patient should lie face down on the fluoroscopy table. The real-time fluoroscopic images help the surgeon to recognize the exact location of the kidney. It needs to use the contrast dye. The contrast dye is injected via the blood or into the urinary tract. The surgeon identifies the approach for the optimum access to urinary tract and avoids the surrounding abdominal organs.

The surgeon makes a small 1 cm cut in your flank area (between the last rib and iliac crest of the pelvis). Then, he/she passes a needle through the cut into the kidney. This is done under x-ray guidance. Next, the surgeon passes a guide wire through the needle to allow the dilators to be used. They enlarge the tract. It helps him/her to break the stone up and remove it from the body.

Then, the surgeon inserts a nephroscope to visualize the area. He/she grasps the smaller stones with a forceps and basket and removes them from the kidney without fragmentation. Sometimes, other devices, such as laser or ultrasonic are used during PCNL to break the stone up before removal. After the removal of stones and fragments, the surgeon inserts a nephrostomy tube to allow for drainage which remains for 24 - 48 hours. It may not be inserted in some cases.

PCNL complications

Stone removal by PCNL results in less post-operation pain and shorter recovery time. Further, it has a significant success rate for clearing all stones in one session compared to other techniques, such as ESWL that may often require several sessions. Although PCNL has proven to be very safe, it may have some potential complications like other surgical procedure, such as bleeding, infection, tissue/organ injury, conversion to open surgery, and failure to remove the stone.

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