What PCNL Is

PCNL is the operation used for large kidney stones. The word means "through the skin". The surgeon makes a puncture of about 1 cm in your back, passes a thin telescope into the kidney, and takes the stone out directly. It clears big stones in one go, and it avoids the large cut that open surgery would need.

When It Is Used

PCNL Is Usually the Choice For
  • Stones bigger than 20 mm
  • Staghorn stones — branching ones that fill much of the kidney
  • Stones in the lower part of the kidney, where shock waves work less well
  • Stones that shock waves or laser have already failed to clear
  • Kidneys of an unusual shape or position
  • A stone together with a narrowing at the kidney outlet

What Happens on the Day

You are fully asleep. The operation takes one to two hours.

  1. Position: Most often face-down. Some surgeons work with you on your side or back instead. It is fair to ask which yours prefers.
  2. A fine tube goes up the natural passage first, to outline the inside of the kidney on X-ray.
  3. The puncture: Guided by X-ray or ultrasound, a needle goes through the skin of the back into the kidney. A guidewire follows.
  4. Widening the track: The opening is stretched to about 1 cm so the telescope can pass.
  5. Removing the stone: It is either lifted out whole, or broken up first and the pieces washed out.
  6. A drainage tube is left in the kidney at the end. It usually comes out after a day or two.

Mini-PCNL

Mini-PCNL uses a narrower track — under 5 mm rather than about 10 mm. That means a smaller puncture, less bleeding and a quicker recovery. It suits stones of roughly 15 to 30 mm where the kidney is a normal shape. Which version is right for you depends on the stone and your anatomy, and it is decided after looking at your scan.

Recovery

  • In hospital: Usually two to three nights. One to two for mini-PCNL.
  • The drainage tube comes out before you go home, once the urine runs clear.
  • Light activity: Five to seven days after you get home.
  • Back to work: Two to three weeks for a desk job. Four to six weeks for heavy physical work.
  • A follow-up scan at four to six weeks checks that nothing is left behind.
  • Pain: Usually handled by paracetamol and an anti-inflammatory. Ring the surgeon if it is worse than that.
Risks Worth Knowing

All surgery carries risk, and you should talk these through before agreeing to it. Bleeding heavy enough to need a transfusion happens in a small number of cases. Infection can follow, which is why the urine is made sterile beforehand. Injury to nearby structures is rare. Sometimes fragments are left and a second procedure is needed.

Been told you need PCNL?

Bring the CT images to your appointment. Whether standard or mini-PCNL suits you is decided from the scan.

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Full guide: kidney and ureteric stones → · Causes and stone types →

Dr. Azhar Anwar M.Ch. Urology (DMC Ludhiana) · DNB General Surgery · Urologist & Andrologist, Varanasi