Percutaneous Nephrolithotomy

About Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy, often called PCNL, removes kidney stones through a small tract made directly through the skin of the back into the kidney. It is generally the preferred treatment for large stones, including staghorn stones that fill much of the collecting system, and for stones that have not responded to less invasive methods. Under imaging guidance with fluoroscopy or ultrasound, a needle is passed into the kidney, a guidewire is placed and the tract is widened so that a sheath and nephroscope can be inserted. Stones are then broken up with ultrasonic, pneumatic or laser devices and removed. Miniaturized versions use smaller tracts. At the end of the procedure a drainage tube or ureteral stent may be left in place. PCNL was developed in the 1970s and 1980s and largely replaced open surgery for complex kidney stones. It is performed under general anesthesia, either prone or supine, and usually involves a short hospital stay. Analysis of the removed stone helps guide later prevention strategies by a specialist.