PCNL surgery for kidney stone, or percutaneous nephrolithotomy, is a minimally invasive procedure used to remove kidney stones through a small opening made through the skin into the kidney.
PCNL is particularly considered when a kidney stone is large, complex, difficult to treat with other methods or unlikely to be cleared effectively with less invasive approaches.
Unlike medicines that may help selected small stones pass, PCNL allows the stone to be directly fragmented and removed from the kidney.
The decision to perform PCNL depends on factors such as:
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Stone size
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Stone location
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Number of stones
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Stone composition and density
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Kidney anatomy
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Urinary obstruction
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Infection
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Previous stone procedures
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Overall kidney function
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General health of the patient
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides specialist evaluation of kidney function and kidney-related complications and can coordinate appropriate care with urological specialists when surgical stone removal is required.
Why Is PCNL Used for Kidney Stones?
Not every kidney stone requires surgery.
Small stones may sometimes pass naturally or be managed with observation and medical treatment. However, larger stones may have a lower likelihood of spontaneous clearance and may cause obstruction, recurrent infection, pain or deterioration in kidney function.
PCNL may be considered when:
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The stone burden is large
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Multiple stones are present
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The stone is complex or difficult to clear
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Other treatments are unlikely to provide adequate clearance
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A previous stone procedure has not completely cleared the kidney
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The stone is causing significant obstruction or complications
The choice of treatment should be based on imaging and individual clinical assessment rather than stone size alone.
How Does PCNL Surgery Work?
PCNL is performed through a small access tract created directly into the kidney.
The general process involves:
1. Preoperative Assessment
Before the procedure, the medical team reviews imaging, kidney function, urine tests and other relevant health information.
A CT scan or other imaging may be used to understand:
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Exact stone location
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Stone size
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Number of stones
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Kidney anatomy
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Urinary obstruction
2. Anesthesia
PCNL is generally performed under anesthesia so that the patient does not experience the procedure.
3. Kidney Access
A small puncture is made through the skin, usually in the back or side, to create access to the kidney.
Imaging guidance is used to help establish the appropriate access route.
4. Stone Fragmentation
A specialized instrument is passed through the access tract into the kidney.
The stone can be broken into smaller pieces using appropriate energy-based instruments.
5. Stone Removal
The fragmented stone material is removed through the access tract.
Depending on the stone burden, more than one access tract or a staged procedure may occasionally be considered.
6. Drainage and Recovery
A temporary nephrostomy tube or ureteral stent may be placed in selected patients after the procedure.
The exact approach varies according to the patient's anatomy and the complexity of the stone.
Who May Need PCNL?
PCNL is generally considered for selected patients with larger or complex renal stone burdens.
A doctor may discuss PCNL when a patient has:
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A large kidney stone
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Multiple kidney stones
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Staghorn or branching stones
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Complex stone burden
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Stones causing recurrent urinary infection
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Persistent obstruction
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Stones that are difficult to treat effectively with other procedures
PCNL is not automatically required simply because a stone is present.
For smaller stones, other treatments may be more appropriate.
PCNL Compared With Other Kidney Stone Treatments
The treatment of kidney stones can involve several approaches.
Observation
Selected small, uncomplicated stones can sometimes be monitored if there is no significant obstruction, infection or other indication for active treatment.
Medical Treatment
Medicines may help control pain or facilitate passage in selected ureteral stones.
They generally do not remove or dissolve most kidney stones.
ESWL or Shock Wave Lithotripsy
Shock waves generated outside the body can fragment selected stones.
Its effectiveness depends on factors such as stone size, location, density and anatomy.
Ureteroscopy and Laser Lithotripsy
A small scope is passed through the urinary tract to reach the stone. Laser energy can fragment the stone into smaller pieces.
This approach may be suitable for many kidney and ureteral stones, although larger stone burdens can sometimes require staged treatment.
PCNL
PCNL provides direct access to the kidney and allows larger stone fragments to be removed through the access tract.
The appropriate procedure should be selected after reviewing the stone characteristics and patient's health.
What Tests Are Done Before PCNL?
Preoperative assessment is important for reducing complications and planning the procedure.
Depending on the patient's condition, tests may include:
Imaging
A CT scan or ultrasound may be used to evaluate the stone and urinary system.
Urine Testing
Urinalysis and urine culture may be performed to identify urinary infection.
An active urinary infection generally needs appropriate treatment before definitive stone removal.
Blood Tests
The treating team may check:
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Serum creatinine
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eGFR
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Hemoglobin
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Platelet count
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Electrolytes
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Blood glucose
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Other tests required before anesthesia
Medical Assessment
The doctor may also review:
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Blood pressure
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Diabetes
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Heart and lung conditions
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Blood-thinning medicines
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Previous surgeries
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Previous stone procedures
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Other medications
Why Must Infection Be Checked Before PCNL?
Urinary infection is an important consideration before kidney stone surgery.
A stone can sometimes obstruct urine drainage and contribute to recurrent infection.
If infection is present, definitive stone treatment may need to be delayed until the infection is appropriately controlled.
In a patient with an infected and obstructed urinary system, urgent drainage may be necessary before definitive stone removal.
Possible warning symptoms include:
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Fever
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Chills
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Severe flank pain
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Vomiting
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Reduced urine output
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Feeling extremely unwell
These symptoms require prompt medical assessment.
Is PCNL Painful?
PCNL is performed under anesthesia, so significant pain during the procedure is not expected.
After surgery, some patients may experience:
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Back or flank discomfort
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Mild blood in urine
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Temporary urinary irritation
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Discomfort related to a nephrostomy tube or ureteral stent
Pain medicines are usually provided according to the patient's needs.
Pain severity and recovery can vary depending on the complexity of the procedure and the individual patient.
How Long Does PCNL Take?
The duration of PCNL is not the same for every patient.
It can depend on:
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Number of stones
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Stone size
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Stone location
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Kidney anatomy
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Difficulty establishing access
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Amount of stone fragmentation required
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Whether the procedure is staged
The treating surgeon can provide a more specific estimate after reviewing the patient's imaging.
How Long Is Recovery After PCNL?
Recovery varies from person to person.
After the procedure, the medical team monitors:
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Urine output
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Blood pressure
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Pain
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Bleeding
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Kidney function
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Signs of infection
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Drainage from any temporary tube
Some patients return to normal activities relatively quickly, while others may need more recovery time after a complex or staged procedure.
Follow-up imaging may be recommended to determine whether residual stone fragments remain.
What Can Happen After PCNL?
Temporary symptoms may include:
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Blood-tinged urine
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Mild flank discomfort
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Urinary frequency
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Burning during urination
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Tiredness
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Discomfort from a stent or nephrostomy tube
These symptoms should be discussed with the treating team if they are severe, persistent or worsening.
Possible Risks of PCNL Surgery
PCNL is generally considered an established treatment for appropriate kidney stone cases, but like any procedure, it has potential risks.
Possible complications include:
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Bleeding
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Infection
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Injury to surrounding structures
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Residual stone fragments
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Urinary leakage
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Need for additional procedures
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Blood transfusion in uncommon cases
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Rare complications involving nearby organs
The individual risk depends on factors such as stone complexity, kidney anatomy, previous procedures and overall health.
The surgeon should explain the expected benefits and potential risks before treatment.
Can PCNL Completely Remove a Kidney Stone?
PCNL can achieve substantial stone clearance, particularly for appropriately selected large or complex kidney stones.
However, complete clearance is not guaranteed in every case.
Residual fragments may remain because of:
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Multiple stones
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Difficult anatomical locations
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Complex branching stones
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Limited access
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Stone burden
Some patients may require a second-look procedure, ureteroscopy, ESWL or another treatment to address residual stones.
Can PCNL Be Done for Multiple Kidney Stones?
Yes.
PCNL may be considered when several stones are present within the kidney, particularly when the overall stone burden is substantial.
The treatment strategy depends on where the stones are located and how they are distributed within the kidney.
In complex cases, treatment may be staged rather than attempting to remove everything during one procedure.
What Is Mini-PCNL?
Mini-PCNL is a variation of percutaneous nephrolithotomy that uses a smaller access tract than conventional PCNL.
The smaller tract may offer certain advantages in selected patients, including potentially reduced bleeding, although suitability depends on the stone and patient characteristics.
Mini-PCNL is not automatically appropriate for every stone.
The surgeon chooses the access size and technique based on stone burden, anatomy and treatment objectives.
What Is a Staghorn Stone?
A staghorn stone is a large branching kidney stone that can occupy multiple parts of the kidney's collecting system.
These stones can be associated with recurrent urinary infections and kidney complications.
PCNL is commonly an important component of treatment for significant staghorn stone burdens.
Some patients may require multiple procedures to achieve adequate stone clearance.
Can PCNL Damage the Kidney?
PCNL involves creating a controlled access tract into the kidney, so there is a possibility of bleeding or injury to renal tissue.
However, the procedure is designed to remove stones while minimizing unnecessary damage.
The potential benefits and risks should be considered in relation to the consequences of leaving a large, obstructing or infection-associated stone untreated.
Individual risk assessment is especially important in patients who already have impaired kidney function.
What Happens to the Kidney After PCNL?
After successful stone treatment, urine drainage may improve when a stone had been causing obstruction.
The effect on kidney function depends on:
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Duration of obstruction
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Severity of obstruction
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Presence of infection
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Pre-existing kidney disease
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Number and size of stones
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Whether permanent kidney damage has occurred
Removing a stone does not necessarily restore kidney function if long-standing damage is already present.
PCNL and Kidney Function
Kidney function may be evaluated before and after stone treatment.
Common measurements include:
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Serum creatinine
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eGFR
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Urine examination
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Electrolytes
A significant change in kidney function may require further investigation.
Patients with chronic kidney disease, a solitary kidney or previous kidney injury may require particularly careful treatment planning.
What Should You Do After PCNL?
After discharge, follow the treating team's instructions regarding:
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Prescribed medicines
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Fluid intake
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Physical activity
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Wound care
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Stent or catheter management
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Follow-up appointments
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Imaging
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Stone analysis
Do not independently remove a ureteral stent or nephrostomy tube unless specifically instructed.
How Can Kidney Stones Be Prevented After PCNL?
PCNL removes an existing stone but does not necessarily eliminate the reason why stones formed.
Prevention may involve:
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Maintaining appropriate fluid intake
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Reducing excessive dietary sodium
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Following an individualized dietary plan
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Stone analysis
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Metabolic evaluation in selected recurrent stone formers
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Treating urinary infections when relevant
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Taking prescribed preventive medicines
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Regular follow-up
The prevention strategy should be tailored to the type of stone and the patient's medical history.
When Should You Seek Medical Help After PCNL?
Contact the treating medical team promptly if you develop:
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High fever
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Chills
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Severe or worsening pain
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Persistent vomiting
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Very little or no urine
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Heavy or worsening bleeding
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Severe weakness
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Difficulty breathing
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Confusion
These symptoms can indicate infection, bleeding, obstruction or another complication requiring assessment.
PCNL Surgery at Prabhakar Bhurke Clinic
At Prabhakar Bhurke Clinic, Dr. Sandip Prabhakar Bhurke, super specialist nephrologist and transplant physician, provides comprehensive evaluation of kidney function and kidney-related conditions.
For patients with kidney stones, assessment may include:
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Review of CT or ultrasound reports
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Kidney-function evaluation
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Assessment of urinary obstruction
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Evaluation for urinary infection
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Review of previous stone procedures
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Assessment of recurrent stone risk
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Medical management of kidney-related complications
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Coordination with an appropriately qualified urological surgeon when PCNL or another stone-removal procedure is indicated
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Follow-up kidney care after stone treatment
Because PCNL is a stone-removal procedure performed by urological surgical specialists, patients may require coordinated nephrology and urology care depending on their kidney function and overall medical condition.
Frequently Asked Questions
What is PCNL surgery for kidney stone?
PCNL, or percutaneous nephrolithotomy, is a minimally invasive procedure in which a small access tract is created through the skin into the kidney so that a stone can be fragmented and removed.
Is PCNL suitable for a large kidney stone?
PCNL is often considered for larger or complex kidney stones, but the appropriate procedure depends on stone size, location, anatomy, density, infection status and the patient's health.
Is PCNL better than laser treatment?
Neither procedure is universally better. PCNL and ureteroscopy with laser lithotripsy have different applications, and the choice depends on the characteristics of the stone and the patient.
How many days does it take to recover from PCNL?
Recovery varies. The hospital stay and return to normal activities depend on the complexity of the procedure, the patient's health and whether additional treatment is required.
Can kidney stones come back after PCNL?
Yes. PCNL removes existing stones but does not necessarily eliminate the factors responsible for stone formation. Preventive evaluation can reduce recurrence risk.
Is PCNL a major surgery?
PCNL is minimally invasive compared with traditional open stone surgery, but it is still a surgical procedure performed under anesthesia and has potential complications.
Can PCNL be performed if there is a urinary infection?
An active urinary infection requires appropriate management before definitive stone removal in most circumstances. An infected obstructed urinary system may require urgent drainage before stone treatment.
Does PCNL affect kidney function?
The effect depends on the patient's underlying kidney health, stone burden, obstruction and complications. Kidney function is generally assessed as part of treatment planning and follow-up.
Conclusion
PCNL surgery for kidney stone is an important treatment option for patients with selected large or complex renal stones.
The procedure allows the medical team to reach the kidney through a small skin incision, fragment the stone and remove the resulting pieces. Compared with waiting for a large stone to pass naturally, PCNL can provide a direct method of stone removal when active treatment is indicated.
However, PCNL is not necessary for every kidney stone. The appropriate treatment depends on stone size, location, density, anatomy, obstruction, infection, previous treatment and kidney function.
Before undergoing PCNL, patients should have appropriate imaging, kidney-function assessment and evaluation for urinary infection. After treatment, follow-up is important to identify residual stones and reduce the chance of recurrence.
For kidney-function assessment and coordinated kidney care, patients can consult Dr. Sandip Prabhakar Bhurke at Prabhakar Bhurke Clinic. When a surgical stone procedure is required, appropriate urological coordination can be arranged according to the patient's individual needs.
Medical Disclaimer
This article is intended for general educational and informational purposes only and does not constitute medical advice, diagnosis or treatment. PCNL is a surgical procedure and is not appropriate for every kidney stone. The decision to undergo PCNL depends on stone size, location, anatomy, density, obstruction, infection status, kidney function and the patient's overall health. Potential risks include bleeding, infection, residual stones and the need for additional procedures. Do not delay treatment or attempt to manage a large or obstructing kidney stone with home remedies alone. Fever, chills, severe flank pain, very little or no urine, persistent vomiting, heavy bleeding, confusion or rapidly worsening symptoms require prompt medical attention. Consult a qualified urologist and nephrologist for an individualized treatment plan.
