What happens during PCNL
Under anaesthesia, a fine tract about a centimetre wide is made through the skin of the back directly into the stone-bearing part of the kidney, guided by X-ray or ultrasound. A nephroscope goes down that tract, the stone is broken with a pneumatic or laser lithotripter, and the fragments are suctioned or picked out — not left to pass on their own.
- No open cut; a single keyhole in the flank
- Stone clearance checked on table before closing
- A nephrostomy tube or DJ stent may be left for a few days
- Usually two to three days in hospital
Who PCNL is right for
Size and hardness decide this. Very large, very dense or branched stones cannot be cleared efficiently by flexible scope alone, and trying to do so leads to long operating times, incomplete clearance and repeat procedures.
- Stones larger than 2 cm
- Staghorn or partial staghorn stones
- Hard stones that resisted ESWL or RIRS
- Stones in a kidney with abnormal anatomy or a narrow ureter
- Lower pole stones with an unfavourable angle for RIRS
Recovery after PCNL
You are walking the same evening or the next morning. Mild blood in the urine for a few days is expected. Desk work usually resumes in about a week, heavy lifting after three to four weeks. A check ultrasound or X-ray at around four weeks confirms the kidney is clear before the stent comes out.
Where a smaller tract is enough, mini PCNL is used instead — less bleeding, less pain, and often a tubeless recovery.
PCNL (Percutaneous Nephrolithotomy) — common questions
Is PCNL a major surgery?
It is a keyhole procedure, not open surgery, but it is done under general or spinal anaesthesia and needs a short hospital stay. Most patients are out of bed the same day and back to light routine within a week.
How long does PCNL take?
Typically 45 to 90 minutes depending on stone size, hardness and the number of calyces involved. Staghorn stones take longer and occasionally need a planned second sitting.
Will I need a nephrostomy tube after PCNL?
Sometimes. A small drainage tube for 24 to 48 hours is used when there is bleeding or residual stone to clear. In straightforward cases a tubeless PCNL with just a DJ stent is possible.
Can both kidneys be operated at the same time?
Usually not in one sitting. Bilateral stones are staged a few weeks apart so that one kidney is always working normally while the other recovers.
Reviewed by Dr. Kinjal Banerjee, MBBS, MS (General Surgery), DNB (Urology) — Urologist, Renal Transplant & Robotic Surgeon, Faridabad. This page explains pcnl (percutaneous nephrolithotomy) in general terms; your own treatment plan depends on your reports and examination.