PCNL (Percutaneous Nephrolithotomy) is a minimally invasive surgery used to remove large or complex kidney stones directly through a small incision in the back.
“Percutaneous” = through the skin
“Nephro” = kidney
“Lithotomy” = removing stones
It is usually chosen when the stone is too large (>2 cm), very hard, or when other treatments like ESWL or RIRS may not be effective.
Kidney stones larger than 2 cm
Staghorn stones (stones filling large parts of the kidney)
Stones resistant to other treatments (laser, shockwave)
Stones causing repeated infections or blockages
Multiple stones in the kidney
Patient under general or spinal anesthesia
A small (1 cm) cut is made on the back
A nephroscope (thin tube with a camera) is inserted into the kidney
The stone is broken using ultrasonic, pneumatic, or laser devices
Stone pieces are removed through the tube
A nephrostomy tube or stent may be placed temporarily for urine drainage
✅ Effective for very large stones
✅ Higher stone clearance rate than other methods
✅ Less invasive than open surgery
✅ Shorter hospital stay compared to open surgery
Hospital stay: usually 2–4 days
Rest required for about 1–2 weeks
Drink plenty of fluids to prevent new stones
Stent/tube (if placed) usually removed in 1–2 weeks
Follow-up imaging (ultrasound/CT scan) to check clearance
Mild bleeding
Infection
Injury to nearby organs (rare, since guided by imaging)