Percutaneous nephrolithotomy is a surgical procedure to remove kidney stones that are too large to pass on their own or don’t respond to other treatments. The procedures takes three to four hours to complete. Risks include blood in your pee, blood clots, infection and healing problems. Recovery takes two to four weeks.
Advertisement
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Video content: This video is available to watch online.
View video online (https://cdnapisec.kaltura.com/p/2207941/sp/220794100/playManifest/entryId/1_nvochjhy/flavorId/1_5f3sgelj/format/url/protocol/https/a.mp4)
When nothing else works to treat kidney stones, we turn to percutaneous nephrolithotomy. Learn how this surgery works, what to expect and its risks.
Percutaneous nephrolithotomy (PCNL) is surgery to remove kidney stones that are too large to pass on their own. Healthcare providers usually suggest a percutaneous nephrolithotomy (per-kew-TAY-nee-us NEF-ro-leh-THOT-oh-mee) when other kidney stone treatments don’t work or aren’t possible.
Advertisement
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
“Percutaneous nephrolithotomy” is a big word. But what does it mean? “Percutaneous” means that the procedure occurs through the skin. “Nephrolithotomy” means the removal of a calculus (another word for a kidney stone) from a kidney.
PCNL is a minimally invasive surgery. That means it:
But it’s still a major surgery that’s more invasive than other kidney stone treatments.
Percutaneous nephrolithotomy is a common treatment for large kidney stones. The best candidate for PCNL is someone who:
Your provider will review all of your options with you. Together, you’ll reach a shared decision regarding your treatment goals and outcomes.
Before the procedure, you’ll meet with your healthcare provider. They’ll:
Advertisement
They may also recommend imaging tests (CT scan, ultrasound, X-ray) to get a better view of the kidneys and the stone.
Your provider will also give you specific directions on eating and drinking. You shouldn’t eat or drink anything after midnight the night before your surgery. If you must take medications, you should take them with a small sip of water.
A special team of healthcare providers will perform percutaneous nephrolithotomy. The team typically includes:
During most PCNL procedures, you’ll lie on your stomach (prone). This allows your urologist to access your kidney through your back. But sometimes, urologists place you in other positions. They may place you on your back (supine) or on your back with a cushion under your flank (modified supine).
Your anesthesiologist will put you under with general anesthesia. You won’t be awake, won’t move and won’t feel any pain during the procedure.
During the PCNL, your urologist will:
In some cases, your urologist may use a laser or shock-wave device (lithotripter) to break the stone into smaller pieces before taking it out. They may also insert a drainage tube or ureteral stent. These help drain pee and promote healing.
PCNL usually takes two to four hours to complete.
After PCNL, healthcare providers will:
They may also send the kidney stone to a lab. Lab technicians will figure out what’s in your kidney stone. Identifying what makes it up can help determine its cause. This can prevent new stones from forming.
Most people need to stay in the hospital for one day after surgery. This allows providers to make sure you’re recovering as expected, starting to heal and not having any issues with managing your pain.
You may have small amounts of blood in your pee for a week or two after PCNL. This is normal.
The main advantage of the procedure is that it removes kidney stones that are too big to pass on their own or respond to other treatments. It’s also a minimally invasive procedure. That means you’ll heal faster than with open surgery.
The PCNL success rate is good. The success rate is about 75% to 98%.
Advertisement
All surgeries have risks, even minimally invasive procedures. Some percutaneous nephrolithotomy risks include:
For most people, the procedure is moderately painful. Your healthcare provider may prescribe pain relievers. If you have a drainage tube, your pain should go down after your provider removes it. Sometimes, the ureteral stent is the most painful part of the procedure.
Your body is unique, so recovery times may vary. But in general, most people recover two to four weeks after percutaneous nephrolithotomy.
As you recover, it’s important to avoid strenuous physical activity. This includes heavy lifting. Don’t lift anything heavier than a gallon of water (about 8.5 pounds) for at least two weeks.
Most people can return to work or school about a week after PCNL.
If you have a more physically demanding job, it’s a good idea to take at least two weeks off work.
Schedule a checkup with your healthcare provider four to six weeks after your PCNL.
Advertisement
Call your healthcare provider right away if you have any complications. These may include:
Kidney stones can cause a lot of pain. They can be even more frustrating if they’re large or oddly shaped — they may not pass on their own, and they may be too big for simpler treatments. But a percutaneous nephrolithotomy is a relatively safe and effective procedure for removing stubborn stones.
Talk to your healthcare provider about any concerns. They’ll answer any questions and go into greater detail about the procedure, including all possible outcomes and risks.
Advertisement
Sign up for our Health Essentials emails for expert guidance on nutrition, fitness, sleep, skin care and more.
Learn more about the Health Library and our editorial process.
Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.
Cleveland Clinic’s health articles are based on evidence-backed information and review by medical professionals to ensure accuracy, reliability and up-to-date clinical standards.
Kidney stones can be a painful interruption in your busy life. At Cleveland Clinic, we’ll craft a treatment plan that works for you.
