Percentaneous Nephrolithotomy (PCNL) is a surgical procedure used to treat large kidney stones which are over 2cm in size. This involves ‘key-hole’ surgery through the skin into the kidney in which stone breaking instruments are inserted. This treatment may also be suitable for patients whose stones are difficult to locate on X-ray or are particularly hard.
During the procedure patients will be under general anaesthetic and therefore asleep. A small telescope will examine the bladder, urethra and kidneys and then a dye will be inserted into the kidneys to enhance the X-ray. A fine needle will be placed into the kidney, through which a micro-telescope will be inserted the help guide the surgeon to find the stone. Once identified it will be broken up and removed.
The aim is to remove all stone fragments in one treatment, although sometimes this is not possible. The consultant will discuss in detail the possibility of further key-hole surgery or a lithotripsy.
Patients will most likely remain in hospital for one to two nights post-operatively. After the procedure the patient may feel some pain, however the nurse will supply painkillers. A catheter will remain to drain both the bladder and the kidney which will be removed before the patient leaves hospital.
PCNL is generally considered to be a safe procedure, however, all medical procedures carry an element of risk and the consultant will discuss this in detail. The most common complication following surgery is an infection, however all patients are given antibiotics to prevent this happening. Occasionally, a kidney puncture occurs which requires a blood transfusion, and very rarely significant bleeding can occur and this is treated through an embolisation, the deliberate blocking of a blood vessel.