A tiny instrument breaks up a stone.
UC San Diego Health's
Comprehensive Kidney Stone Center offers percutaneous nephrolithotomy (PNL), a type of minimally invasive surgery to break apart and remove large kidney stones. During this procedure, your surgeon makes a small incision in your back and passes a tiny scope into the kidney to break up the kidney stone before removing it. Ultrasound lithotripsy is the most common technology used to fragment the stones.
PNL is typically a three-day inpatient procedure. The ideal stone size for the use of PNL is more than 1.5 cm. Although this is the most invasive
treatments for kidney stones, it is by far the most effective one to remove large stones.
Surgery to Remove Kidney Stones
The percutaneous nephrolithotomy procedure requires general anesthesia and takes approximately three hours. You 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 urethra 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 seven days for suture removal of the back incision.
Post-operative pain is variable and oral medications along with antibiotics will be given before discharge. The post-operative pain usually disappears in two weeks. You can usually return to work after the back suture is removed.
After your post-operative visit, you will be asked to return to our clinic in two months. You will need to have completed:
- A 24-hour urine collection. This collection should be done about four weeks after the surgery
- An ultrasound of the kidney six weeks after surgery. This is to ensure the kidney has healed from the surgery.
Percutaneous Nephrolithotomy Outcomes
In PNL, stone-free rates the highest among all procedures, typically greater than 90 percent
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.