Percutaneous nephrolithotomy or nephrolithotripsy is a procedure to remove kidney stones from the kidney through a small incision in the skin.
Nephrolithotomy is the removal of an intact stone.
Nephrolithotripsy is the removal of a stone that had been broken apart with other treatments, usually high frequency sound waves.
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These procedures are done to remove large kidney stones. Larger stone can cause damage and blockages as they pass through the urinary system. This procedure will remove them before they cause damage.
Other treatments are often tried first to manage kidney stones. Percutaneous nephrolithotomy or nephrolithotripsy may be chosen when:
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review possible problems, like:
Before your procedure, talk to your doctor about ways to reduce risk of problems, such as:
Your doctor will review tests that were already done. You may also need a physical exam if one has not been done recently.
Talk to your doctor about:
General anesthesia will be used. It will block any pain and keep you asleep through the procedure.
The surgeon will make a small incision in the back. A wire is guided through the kidney and next to the stones to make a pathway. X-rays will help locate the kidney stone(s) and map the path to them. The wire can help to widen the pathway so that an instrument with a small camera and surgical tools can be inserted. The stone may be broken apart with a probe or laser. The tools can then grab or suction out the stone pieces.
A drainage tube will be placed in the kidney. It will drain urine away from the kidney while the area heals. The incision will be stitched or stapled. The area may be covered with a bandage.
3 to 4 hours
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
The usual length of stay is 1 to 3 days. Complications may lead to a longer stay.
Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:
Fatigue can continue for up to a month. Exercises and regular activity may be recommended to help your recovery.
Call your doctor if any of these occur:
If you think you have an emergency, call for emergency medical services right away.
National Institute of Diabetes and Digestive and Kidney Diseases
Urology Care Foundation
Canadian Urological Association
The Kidney Foundation of Canada
Gross AJ, Knipper S, Netsch C. Managing caliceal stones. Indian J Urol. 2014;30(1):92-98.
Kidney stones. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/kidney-stones. Accessed January 29, 2021.
Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis. Accessed January 29, 2021.
Percutaneous nephrolithotomy (PCNL). University of Florida Department of Urology website. Available at: http://urology.ufl.edu/patient-care/stone-disease/procedures/percutaneous-nephrolithotomy-pcnl. Accessed January 29, 2021.
Percutaneous nephrolithotomy/nephrolithotripsy. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneystones_PNN. Accessed January 29, 2021.
Wong B. Percutaneous nephrolithotomy. The Hong Kong Medical Diary. 2010;14(10):14-17. Available at: http://www.fmshk.org/database/articles/04mb3_2.pdf. Accessed January 29, 2021.
Last reviewed March 2021 by EBSCO Medical Review Board Adrienne Carmack, MD