Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL) is a state-of-the-art, minimally invasive surgical procedure designed to remove large kidney stones (greater than 2 cm in diameter) or multiple small stones that cannot be treated effectively with non-invasive techniques like extracorporeal shock wave lithotripsy (ESWL) or medication.

This advanced procedure is recommended for patients who have:

• Stones too large for natural passage
• Multiple kidney stones
• Stones resistant to other treatments
• Abnormal anatomy of the urinary tract

How PCNL is Performed

1. Preparation:
   The procedure is carried out under general anesthesia. The patient is positioned on their stomach to allow direct access to the kidney.
2. Incision and Access:
   A small incision (about 1 cm) is made on the patient's back or flank area. Through this incision, a thin tube is inserted into the kidney using real-time imaging (fluoroscopy or ultrasound) to guide access.
3. Stone Removal:
   A nephroscope (a tiny fiber-optic camera) is passed through the tube. Specialized instruments are used to break the kidney stones into smaller pieces, which are then extracted through the tube.
4. Post-Procedure Care:
   A temporary drainage tube (nephrostomy tube) may be placed to ensure urine flow from the kidney. This is typically removed in a few days.

Advantages of PCNL

•  Minimally invasive: Avoids the need for open surgery
•  High success rate for removing large or complex stones
•  Faster recovery compared to traditional surgery
•  Shorter hospital stay (1–2 days typically)
•  Less post-operative pain and smaller scars
•  Available locally at the Advanced Urology Institute, without the need to travel to a tertiary hospital

Recovery and Aftercare

• Most patients can resume light activities within 1 week.
• Follow-up imaging is often recommended to ensure the kidney is stone-free.
• Patients are advised to stay hydrated and follow dietary recommendations to prevent stone recurrence.

Risks and Considerations

While PCNL is generally safe and well-tolerated, as with any surgical procedure, there are potential risks:

• Bleeding
• Infection
• Injury to surrounding organs
• Need for additional procedures (rare)

These risks are minimized when performed by experienced urologists using modern equipment.

Frequently Asked Questions (FAQs)

1. Is PCNL painful?
You will be under general anesthesia during the procedure, so you won’t feel pain. Post-surgical pain is generally mild and manageable with medication.

2. How long will I be in the hospital?
Typically, patients stay in the hospital for 1–2 days after the procedure.

3. Will the stone come back?
While PCNL effectively removes existing stones, new ones can form. Your doctor will provide guidance on diet, hydration, and lifestyle to help prevent recurrence.

4. Is PCNL safe for all patients?
PCNL is safe for most individuals, but suitability depends on factors like overall health, stone size and location, and previous treatments. A urologist will determine if PCNL is right for you.

5. What follow-up is required?
A follow-up appointment is usually scheduled within a few weeks for imaging tests to ensure complete stone clearance and assess kidney function.