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Percutaneous Nephrolithotomy or Nephrolithotripsy

Definition

Percutaneous nephrolithotomy or nephrolithotripsy is a procedure to remove kidney stones from the kidney through a small incision in the skin.

Nephrolithotomy is the removal of an intact stone.

Nephrolithotripsy is the removal of a stone that had been broken apart with other treatments, usually high frequency sound waves.

Kidney Stone
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Reasons for Procedure

These procedures are done to remove kidney stones to prevent damage and blockages as they pass through urinary system.

Other treatments are often tried first to manage kidney stones. Percutaneous nephrolithotomy or nephrolithotripsy may be chosen when:

  • Kidney stones are large or have irregular shape
  • Infection is present
  • Other treatment was not able to reduce or break-up kidney stones or cannot be done

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Blood clots
  • Blood in the urine
  • Obstruction in the ureter, the tube that carries urine from the kidney to the bladder
  • Injury to nearby organs
  • Remaining stone fragments
  • Infection
  • Fluid in the chest
  • Reduced kidney function
  • Recurrence of kidney stones
  • Reaction to anesthesia

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity

What to Expect

Prior to Procedure

Your doctor may do the following:

  • Physical exam
  • Blood and urine tests
  • Electrocardiogram (EKG)—to assess electrical activity of the heart
  • Imaging tests—to help locate stones

You may be asked to stop taking some medications up to one week before the procedure, like:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Blood thinners
  • Antiplatelet drugs

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the procedure.

Description of the Procedure

The surgeon will make a small incision in the back. A wire is guided through the kidney and next to the stones to make a pathway. X-rays will help locate the kidney stone(s) and map the path to them. The wire can help to widen the pathway so that an instrument with a small camera and surgical tools can be inserted. The stone may be broken apart with a probe or laser. The tools can then grab or suction out the stone pieces.

A drainage tube will be placed in the kidney to temporarily drain urine away from the kidney to the outside while the area heals. The incision will be stitched or stapled. The area may be covered with a bandage.

How Long Will It Take?

3-4 hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

The usual length of stay is 1-3 days. Complications may lead to a longer stay.

Post-procedure Care

At the Hospital

Right after the procedure, you will be in a recovery room where your blood pressure, pulse, and breathing will be monitored. Recovery may also include:

  • Pain medications
  • Antibiotics to prevent infection
  • Medication and compression stockings to prevent blood clots
  • X-rays to look for any remaining stone fragments
  • Removal of tube—often within 48 hours of procedure

You will be asked to walk around soon after your surgery. This helps circulate blood and prevents blood clots.

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions
At Home

Fatigue can continue for up to a month of recovery. Exercises and regular activity may be recommended to help your recovery.

Call Your Doctor

Call your doctor if any of these occur:

  • Pain that you cannot control with the medication you were site
  • Redness, warmth, excessive bleeding or drainage from the incision site
  • Signs of infection, including fever or chills
  • Problems with urinating that lasts beyond what you or your doctor expect
  • Increased blood clots in your urine
  • Chest pain or difficulty breathing
  • Persistent nausea or vomiting
  • New or worsening symptoms

If you think you have an emergency, call for emergency medical services right away.

Revision Information

  • National Institute of Diabetes and Digestive and Kidney Diseases

    http://www.niddk.nih.gov

  • Urology Care Foundation

    http://www.urologyhealth.org

  • Canadian Urological Association

    http://cuameeting.org

  • The Kidney Foundation of Canada

    http://www.kidney.ca

  • Gross AJ, Knipper S, et al. Managing caliceal stones. Indian J Urol. 2014;30(1):92-98.

  • Kidney and ureteral stones. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urology/index.cfm?article=32&display=1. Updated January 2011. Accessed March 11, 2014.

  • Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 17, 2014. Accessed March 11, 2014.

  • Percutaneous nephrolithotomy (PCNL). University of Florida Department of Urology website. Available at: http://urology.ufl.edu/patient-care/stone-disease/procedures/percutaneous-nephrolithotomy-pcnl. Accessed March 11, 2014.

  • Percutaneous nephrolithotomy/nephrolithotripsy. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneystones%5FPNN.cfm. Accessed March 11, 2014.

  • Wong B. Percutaneous nephrolithotomy. The Hong Kong Medical Diary. 2010;14(10):14-17. Available at: http://www.fmshk.org/database/articles/04mb3%5F2.pdf. Accessed March 11, 2014.