# What is PCNL Surgery?

Source: https://kidneystonediet.com/pcnl-surgery/
Published: 2024-06-28
Author: Jill Harris, LPN, CHC

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Last week I wrote about two common surgeries: Lithotripsy and Ureteroscopy. Today, we discuss a third type of surgery, PCNL, and why and how it is done.

## **What is PCNL?**

PCNL stands for Percutaneous Nephrolithotomy. It’s a minimally invasive surgical procedure used to remove kidney stones. This method involves making a small incision in the back to access the kidney, allowing the surgeon to remove the stones effectively.

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## **Why Would a Patient Require PCNL?**

Patients may require PCNL for several reasons, primarily related to the size, type, and location of the kidney stones:

## Stone Size

- PCNL is typically recommended for large kidney stones, usually greater than 2 centimeters in diameter.
- Stones of this size are often too large to be passed naturally or treated effectively with other less invasive methods like shock wave lithotripsy (SWL) or ureteroscopy.

## Stone Type

- Certain types of stones, such as cystine, struvite (infection), or calcium oxalate, can be large and hard, making them more challenging to treat with other methods.
- Staghorn calculi, a type of stone that takes on the shape of the kidney’s internal structures, often requires PCNL for complete removal due to its complexity and size.

## Complex Stone Location

- Stones located in parts of the kidney that are difficult to reach through non-surgical means, such as within the renal pelvis or branching into the kidney’s calyces, might necessitate PCNL.

## Other Treatments Failed

- Patients who have not had success with other treatments like SWL (shockwave lithotripsy) or ureteroscopy might be advised to undergo PCNL.
- Recurring or multiple stones that are not treatable through less invasive methods may also require PCNL.

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## How is PCNL Performed?

The PCNL procedure involves several steps:

## **Preoperative Preparation**

- Patients undergo imaging tests like CT scans or X-rays to locate the stones precisely.
- General anesthesia ensures the patient is comfortable and pain-free during the procedure.

## **Access to the Kidney**

- A small incision (about 1 cm) is made in the patient’s back to create a direct pathway to the kidney.
- A nephroscope, a specialized instrument with a camera and tools, is inserted through this incision.

## **Stone Removal**

- Using the nephroscope, the surgeon locates the kidney stones.
- The stones are then broken into smaller pieces using ultrasound, laser, or pneumatic energy.
- The fragments are removed through the nephroscope, and any remaining pieces are washed out.

## **Postoperative Care**

- A temporary tube (nephrostomy tube) may be left in place to drain urine and ensure proper healing.
- The patient typically stays in the hospital for 1-2 days for monitoring and recovery.

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## **Recovery and Benefits of PCNL**

## **Recovery**

- Most patients can resume normal activities within 1-2 weeks post-surgery, with some restrictions on strenuous activities.
- Pain and discomfort are usually manageable with prescribed medications.

## **Benefits**

- PCNL offers a high success rate for removing large and complex stones.
- It minimizes the need for multiple procedures, reducing treatment time and discomfort.

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## **Kidney Stone Prevention**

Preventing new stones is key to avoiding surgery, stents, and suffering. Take my **self-guided Kidney Stone Prevention Video Course** and get the education you need to lower your stone risk. You won’t regret it—guaranteed!

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Your friend and advocate,

Jill