Percutaneous Nephrolithotomy (PCNL)

This operation is carried out for patients with a large kidney stone or those who have failed other forms of treatment. In general, PCNL is only used for more complex stones. Mr Keeley will discuss all relevant options for management of your kidney stone with you to help you come to a decision about which one is most appropriate for you. 

When PCNL is recommended, Mr Keeley will discuss the procedure in detail with you at the time of a consultation as well as on the day of surgery. You will need a general anaesthetic and will meet the consultant anaesthetist on the day of surgery.

The operation is carried out with a small incision in the loin, typically just below the ribs. The urinary collecting system of the kidney is accessed using a fine needle and guidewire under ultrasound and x-ray guidance. This is stretched up to allow for the passage of a hollow tube roughly 1 cm in diameter. A telescope is passed through the tube to reach the stones. The kidney stones are removed intact where possible and otherwise broken with an ultrasound probe or laser and the pieces removed. The stone fragments are sent away for analysis in order to allow for an accurate diagnosis.  

You will have a catheter in to drain urine from your bladder during the procedure. This may be removed while you are still under the anaesthetic or the following morning. You will typically have a nephrostomy tube draining urine from your kidney until it is safe to remove it. Blood tests are carried out the following day to check your blood count and see if your kidneys are functioning properly.

You will be sent home either the following day or a few days after the operation, provided you are well. Mr Keeley will advise you on what you should and should not do after you are home.

You will be reviewed by Mr Keeley in outpatients a few weeks later to check on your recovery and discuss the analysis of the kidney stone. You may need further x-rays or scans to see if all of the stones have been removed. 

For further information, click here to download to leaflets produced by the British Association of Urological Surgeons (BAUS).