Percutaneous Nephrolithotomy

Dr. Sur performs percutaneous nephrolithotomy on a patient with kidney stones.

Dr. Roger Sur highlights the advanced treatment capabilities of UC San Diego Health System’s Kidney Stone Center, and the importance of prevention. Percutaneous Nephrolithotomy (PNL) is a surgical procedure to treat kidney stones. In PNL, your surgeon makes a small incision in your back and passes of a tiny scope into the kidney to break up the kidney stone. Ultrasound lithotripsy is the most common technology utilized to fragment the stones. The procedure is typically a three-day inpatient procedure.

The ideal stone for PNL is larger than 1.5 cm and located in either the kidney. Although this is the most invasive technique for kidney stones, it is by far the most effective for large stones.

What to expect from PNL

The procedure requires general anesthesia and takes approximately 3 hours. Patients are transferred to the ward after awakening in the recovery room.

A ureteral stent is typically placed during the procedure to prevent post operative flank pain. This stent will be seen coming out of the urethrea along with a foley catheter that drains the bladder. A third drain will be left coming from the back incision. It also serves to drain the kidney of urine. All three drains are removed, and patients usually go home on the second day after surgery.

You will return to the clinic after about 7 days for suture removal of the back incision.

Post operative pain is variable and oral medications along with antibiotics will be given prior to discharge. Post-operative pain usually disappears in two weeks. Patients can usually return to work after the back suture is removed.

After your first post-op appointment

You will then return to the clinic in 2 months. You will need to have completed:

  • A 24 hour urine collection. This collection should be done about 4 weeks after the surgery
  • An ultrasound of the kidney 6 weeks after surgery, to ensure the kidney has healed up from the surgery.

Outcomes

Stone free rates the highest among all procedures, typically greater than 90 percent.

Complications

PNL is a safe procedure. Nevertheless complications include and but are not limited to infection, bleeding, need for transfusion (1 percent), risk of additional procedures to completely remove kidney stones and collapsed lung.