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PCNL — Percutaneous Nephrolithotomy

Minimally invasive surgical removal of large kidney stones

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Üroloji department. Book Appointment →

What is PCNL — Percutaneous Nephrolithotomy?

PCNL is the gold standard for renal stones larger than 2 cm, staghorn calculi and complex stone burdens.

A small skin incision (about 1 cm) provides percutaneous access to the renal collecting system, usually through the lower or middle posterior calyx.

A nephroscope is introduced through the tract, and stones are fragmented with ultrasonic, pneumatic, holmium laser or combination lithotripters.

Stone-free rates of 75–90 percent are achieved in single sessions for stones up to 4 cm.

Variants include standard PCNL (24–30 Fr tract), mini-PCNL (14–22 Fr), ultra-mini-PCNL and micro-PCNL for selected indications.

Symptoms

Procedure indication: stone larger than 2 cm, staghorn calculus, lower pole stone over 1 cm, hard stone, or failed shockwave lithotripsy
Preoperative findings: flank pain, hematuria, recurrent urinary tract infection, deteriorating renal function
Postoperative course: flank discomfort, transient hematuria, possible nephrostomy tube drainage
Recovery: hospital stay 1–3 days, return to light activity in 1–2 weeks, full recovery in 4 weeks
Possible complications: bleeding (1–4 percent), infection or sepsis (3–5 percent), pleural injury, residual stones

Risk Factors

Higher risk in patients with anticoagulation, untreated UTI, severe spinal deformity
Increased complication rate in patients with multiple comorbidities or advanced age
Anatomic variants (horseshoe kidney, malrotated kidney) increase technical difficulty
Morbid obesity may complicate access and require longer instruments
Pulmonary disease may limit prone positioning

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Renal stones larger than 2 cm causing symptoms
  • Staghorn calculus regardless of symptoms
  • Failed shockwave lithotripsy or ureteroscopy attempts
  • Recurrent urinary infection associated with stone disease
  • Postoperative warning signs: high fever, severe pain, persistent gross hematuria, oliguria

Treatment Methods

01
Preoperative imaging (non-contrast CT) for stone characterization and planning
02
Treatment of any urinary tract infection before surgery; perioperative antibiotic prophylaxis
03
Prone or supine position under general anesthesia; ultrasound or fluoroscopic-guided puncture
04
Tract dilatation, sheath placement, nephroscopic stone fragmentation and extraction
05
Postoperative tubeless or totally tubeless approach when feasible to reduce pain and stay
06
Imaging at 4–6 weeks (non-contrast CT or KUB) to assess stone-free status
07
Long-term metabolic stone evaluation and dietary/medical prevention of recurrence

Which Department to Visit?

You can visit our Üroloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.