For large or complex kidney stones that cannot be managed with ureteroscopy or shockwave lithotripsy, percutaneous nephrolithotomy provides the most effective stone clearance in a single procedure. A small channel is created directly through the skin into the kidney under X-ray and ultrasound guidance, allowing stones to be precisely fragmented and removed through a minimally invasive access point.
TREATMENTS
Percutaneous Nephrolithotomy (PCNL)
When Is PCNL Recommended?
PCNL is recommended for kidney stones that require a more direct approach than ureteroscopy:
• Large stone burden (>2 cm) or staghorn calculi (stones filling the renal collecting system)
• Hard stone composition (e.g., calcium oxalate monohydrate, cystine) resistant to laser
• Failed or unsuitable ureteroscopy due to stone size, location, or anatomy
• Renal anatomy (horseshoe kidney, calyceal diverticulum) where PCNL provides the best access for complete stone clearance
PCNL Variants
• Standard PCNL: A nephroscope passes directly into the kidney through a ~3cm tunnel that provides direct vision for ultrasonic or laser fragmentation and complete stone removal with larger instruments. Patients may be positioned prone (face-down) or supine (face-up).
• Mini-PCNL: A smaller access channel that reduces bleeding and post-operative pain — suitable for stones in the 10–20 mm range.
• ECIRS (Endoscopic Combined Intrarenal Surgery): PCNL combined with simultaneous ureteroscopy by a second surgeon, allowing greater stone clearance in one session.
• Alternatives: Staged ureteroscopy with suction sheaths may be considered in selected cases; rarely, a poorly functioning stone-filled kidney is best removed (nephrectomy).
Risks and Considerations
All procedures carry risks, which your surgeon will discuss with you in detail. These may include:
• Bleeding, occasionally requiring transfusion or a radiology procedure to stop bleeding (rare)
• Infection or sepsis, treated promptly with antibiotics
• Injury to surrounding organs (rare)
• Residual fragments requiring a planned second procedure
Recovery at a glance: Usually 1–3 nights in hospital; avoid heavy lifting for two weeks.
1
Pre-Operative Planning
A non-contrast CT provides detailed stone mapping (size, location and kidney anatomy) to plan the safest and most effective access point.
2
Guided Renal Access
Under general anaesthesia, access to the kidney is achieved using X-ray and ultrasound guidance. A working channel is dilated to allow the nephroscope to enter the kidney.
3
Stone Fragmentation and Removal
Stones are fragmented using ultrasonic lithotripsy, laser energy, or a combination, and the fragments are removed under direct vision.
4
Outcome Monitoring
Post-operative X-ray or CT confirms stone clearance. A nephrostomy tube or ureteric stent may be left temporarily. Kidney function and stone prevention are reviewed at follow-up.
Our Approach
