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by Carmack A

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
IMAGE
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Reasons for Procedure

These procedures are done to remove large kidney stones. Larger stone can cause damage and blockages as they pass through the urinary system. This procedure will remove them before they cause damage.
Other treatments are often tried first to manage kidney stones. Percutaneous nephrolithotomy or nephrolithotripsy may be chosen when:
  • Kidney stones are large or irregular in 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 possible 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 reduce risk of problems, such as:
  • Quit smoking
  • Do not drink before procedure
  • Manage chronic disease such as diabetes or obesity

What to Expect

Prior to Procedure

Your doctor will review tests that were already done. You may also need a physical exam if one has not been done recently.
Talk to your doctor about:
  • Arranging for a ride home after the procedure
  • Stopping certain medications up to 1 week before the procedure
  • Not eating or drinking after midnight prior to the procedure

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. It will drain urine away from the kidney 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 to 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 to 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 medicine
  • 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
At Home
Fatigue can continue for up to a month. 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 medications you were given
  • 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 unexpected symptoms
If you think you have an emergency, call for emergency medical services right away.

RESOURCES

National Institute of Diabetes and Digestive and Kidney Diseases
https://www.niddk.nih.gov
Urology Care Foundation
http://urologyhealth.org

CANADIAN RESOURCES

Canadian Urological Association
http://www.cua.org
The Kidney Foundation of Canada
https://www.kidney.ca

References

Gross AJ, Knipper S, Netsch C. Managing caliceal stones. Indian J Urol. 2014;30(1):92-98.
Kidney stones. Urology Care Foundation website. Available at: http://www.urologyhealth.org/urologic-conditions/kidney-stones. Accessed January 29, 2021.
Nephrolithiasis. EBSCO DynaMed website. Available at: http://www.dynamed.com/topics/dmp~AN~T114904/Nephrolithiasis. Accessed January 29, 2021.
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 January 29, 2021.
Percutaneous nephrolithotomy/nephrolithotripsy. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneystones%5FPNN. Accessed January 29, 2021.
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 January 29, 2021.

Revision Information

  • Reviewer: EBSCO Medical Review Board Adrienne Carmack, MD
  • Review Date: 03/2021
  • Update Date: 01/29/2021