PCNL (Percutaneous Nephrolithotomy)
Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgical technique used to remove kidney stones that are large, complex, or located in difficult-to-reach parts of the kidney. It is performed under general anesthesia and is often recommended when other methods—such as ESWL (shock wave lithotripsy) or ureteroscopy—are not effective.
The procedure involves creating a small incision (around 1 cm) in the back to directly access the kidney. Through this tract, a nephroscope and other specialized instruments are inserted to visualize, break, and extract stones. This direct approach allows removal of even very large or multiple stones in a single session.
When is PCNL Recommended?
- Kidney stones larger than 2 cm in diameter.
- Staghorn calculi or complex/multiple stones.
- Stones that cannot be treated effectively with ESWL or RIRS.
- Cases where stones repeatedly cause infection or block urine flow.
How PCNL is Performed
Pre-Surgery Preparation
- Imaging tests (X-ray, ultrasound, or CT scan) to determine stone size and location.
- Blood and urine tests to check for infection and assess kidney function.
- Patients are advised to stop certain medications such as blood thinners before surgery.
Procedure
- Performed under general anesthesia.
- A small incision is made in the back to create a passage to the kidney.
- A nephroscope is inserted to directly view the stone.
- Stones are fragmented using ultrasound or laser energy and removed piece by piece.
- A temporary nephrostomy tube or ureteric stent may be placed to aid drainage and healing.
Duration & Recovery
- The surgery usually lasts 1–3 hours depending on complexity.
- Hospital stay is typically 2–3 days.
- Most patients return to normal activities within 1–2 weeks.
Advantages of PCNL
- Highly effective for large or complex stones.
- Minimally invasive compared to open surgery.
- Small incision with minimal scarring.
- Faster recovery and less blood loss.
- Can remove multiple stones in a single procedure.
Risks & Possible Complications
- Bleeding or infection after surgery.
- Injury to surrounding organs (rare).
- Temporary leakage of urine through the incision site.
- Risks related to anesthesia.
Prevention of Kidney Stones
Even after successful removal, kidney stones may recur. Preventive steps include:
- Stay Hydrated: Drink 2–3 liters of water daily to keep urine diluted.
- Balanced Diet: Limit salt, red meat, and high-oxalate foods like spinach, nuts, and chocolate.
- Maintain Healthy Calcium: Get calcium from diet rather than supplements (unless advised).
- Lifestyle Habits: Stay physically active and avoid prolonged dehydration.
- Regular Medical Check-ups: Periodic urine and blood tests; preventive medications may be prescribed for recurrent stone formers.