Percutaneous Nephrolithotomy (PCNL)

Two plastic kidneys with PCNL on a table with two stereoscopes.

By Dr. Jerry Yuan, M.D.

Percutaneous Nephrolithotomy (PCNL) is the procedure of choice when dealing with large bulky renal stones, especially those of dense consistency.

Standard treatments for routine kidney stones, such as shock wave lithotripsy or endoscopic removal via mini-endoscope through the ureter, are effective in dealing with most stones. However, when confronted with large stones of 1-2 cm or more in size compounded by those of very hard chemical makeup, more definitive steps are required. This is where PCNL comes in.

How Does PCNL Work?

PCNL allows for direct contact of the offending stones with full-size endoscopes & lithotripsy (stone busting) devices and simultaneous removal of fragments to achieve the most expedient & complete stone clearance.

During PCNL, an access or accesses are placed by our radiology specialists in the flank.

Xray of Percutaneous Nephrolithotomy, Needle and access placement

Once in place, the access is then dilated to allow placement of working ports gaining entry into the plumbing system of the kidney where stones reside. Various devices including laser, ultrasound or pneumatic jackhammer like probes are then used to disintegrate the stones, sizable fragments are easily evacuated without the need for the passage which often is not feasible when dealing with a large amount of debris.

Videos of PCNL

Three videos are provided to illustrate the large stones we often encounter or the so-called staghorn stones since they take up the entire interior of the kidney.

Video one is Before.

Video 2 is multiple sessions in progress with marked reduction of stone burden and multiple drainage catheters in place.

Video 3 is post-op with minimum debris remaining.

PCNL typically requires overnight stay and most patients are treated with a single session. Some require multiple sessions days apart to effect a satisfactory result.

If you have any more additional questions about PCNL, click here to contact any of our Georgia Urology experts.