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Percutaneous Nephrolithotomy (PCNL)

What does the procedure involve?

The fragmentation & extraction of kidney stones using a telescope placed into the kidney through a small puncture in the back. This usually includes cystoscopy and x-ray screening.

What are the alternatives to this procedure?

The alternatives to this procedure include:

What should I expect before the procedure?

If you regularly take aspirin or clopidogrel, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery.

Stopping them may reduce the risk of bleeding but this can result in increased clotting, which may also carry a risk to your health. You will need to discuss the risks and benefits of the treatment with your GP or your urologist.

You will usually be admitted to hospital on the same day as your surgery.

You will be asked not to eat and drink for six hours before surgery. Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy. If you are admitted on the day before surgery, you will normally be given antibiotics into a vein to prevent any infection at the time surgery.

Please tell your surgeon (before your surgery) if you have any of the following:

  • An artificial heart valve.
  • A coronary artery stent.
  • A heart pacemaker or defibrillator.
  • An artificial joint.
  • An artificial blood-vessel graft.
  • A neurosurgical shunt.
  • Any other implanted foreign body.
  • A regular prescription for a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel (Plavix®), Brilinta®, or Aspirin.
  • Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.

What happens during the procedure?

Normally, you will be given a full general anaesthetic and you will be asleep throughout the procedure. You will usually be given an injection of antibiotics before the procedure, after you have been checked for any allergies. The operation is usually carried out in a single stage. First, the surgeon inserts a small tube up the ureter into the kidney by using a telescope passed into the bladder. You are then turned on your face and the surgeon will make a puncture hole into the kidney is established, using X-ray as a guide. Finally, the surgeon passes a telescope through the skin into the kidney and the stones are broken down or extracted (pictured).

A catheter is usually left in the bladder at the end of the procedure, together with a drainage tube in the kidney. It may be necessary to puncture the kidney at more than one site if you have many stones scattered throughout the kidney.

What happens immediately after the procedure?

On the day after surgery, you may have a further X-ray to see if all the stones have been cleared. Occasionally, it may be necessary to take an X-ray down the kidney drainage tube using contrast medium. If the X-ray is satisfactory, the tube in your kidney and the bladder catheter will be removed. The site of the drainage tube often leaks for 24 - 48 hours and you will be only be allowed to go home once this leakage has resolved. The average hospital stay may vary considerably but is usually between two and five days.

Are there any side-effects?

Most procedures have possible side-effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.

Common (greater than 1 in 10)

  • Blood in the urine (temporary).
  • Raised temperature (temporary).

Occasional (between 1 in 10 and 1 in 50)

  • Occasionally the surgeon will need to make more than one puncture.
  • There is no guarantee all the stones will be removed and you may need further operations.
  • You may get new stones.
  • The surgeon may not be able to get access to the kidney and you may need further surgery.

Rare (less than 1 in 50)

  • Severe kidney bleeding requiring transfusion, embolisation or, as a last resort, removal of kidney.
  • Damage to the lung, bowel, spleen, or liver – which will need surgery.
  • Kidney damage or infection needing further treatment.
  • Irrigating fluids may get into the blood system and cause a strain on the heart.

What should I expect when I get home?

When you get home, you should drink twice as much fluid as you would normally to flush your system through and keep any bleeding to a minimum. You should aim to keep your urine permanently colourless to reduce the risk of further stone formation.

It may take at least two weeks to recover fully from the operation. You should not expect to return to work within 10 days, especially if your job is physically demanding.

What else should I look out for?

If you develop a fever, severe pain when passing urine, you cannot pass urine or any bleeding gets worse, you should contact your Surgeon or GP immediately. In case of emergency call 000 or attend your nea rest hospital emergency department.

Are there any other important points?

You can prevent further stone recurrence by making changes to your diet and the amount of fluid you drink. If you have not already received a leaflet about this, contact your Urologist.


This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.

Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.