Please be aware that this site uses cookies
More information
Percutaneous Nephrolithotomy (PCNL)

Percutaneous Nephrolithotomy (PCNL)

A PCNL is an operation to remove staghorn calculi (large kidney stones) from the kidney via a small incision through the skin. It is a form of keyhole surgery, and therefore done under general anaesthetic.

This procedure is done by a nephrologist together with a radiologist in the radiology department.

  • If you are on anticoagulant therapy, they should be stopped 3-10 days before the operation as per hospital protocol.
  • Pre-operative bloods and urine specimen should be taken a week before the operation.
  • ECG tracing is necessary if you are aged over 60 and/or with significant cardiac history.
  • You will have nothing to eat six hours before the operation, but can drink water up to two hours before your operation.

During the operation:

  1. A cystocope is passed through the urethra to the bladder and up the ureter to visualise the stone in the kidney.
  2. The kidney is then punctured with a special needle, through the skin, under x-ray guidance.
  3. The punctured tract is then enlarged to allow access for a telescope to pass into the renal collecting system.
  4. The stone is then removed or broken into small pieces.
  5. A nephrostomy tube is then inserted to facilitate stone debris and urine drainage from the kidney collecting system.
  6. A urethral catheter is inserted and in place for 24 - 48 hours to measure and document urine output via the bladder.
  7. The nephrostomy tube will stay in for 24-48 hours. It will be clamped for several hours or overnight and then removed if you do not develop pain, fever or leakage.
  8. An x-ray is usually taken to check that there are no stone fragments before the nephrostomy tube is removed in Imaging Department.
  9. Pressure dressing should be applied to the nephrostomy wound site, and wound dressing kept on until the wound is healed and sealed up.
  10. The risk of septicaemia and kidney haemorrhage should be closely monitored and the patient should be made aware.
  11. Daily routine bloods are necessary until discharge.