Percutaneous Nephrolithotomy for Kidney Stones

Overview

What are kidney stones?

Kidney stones form when waste substances in the urine like minerals, acid or salts build up and crystallise to form hard stones in the kidneys.

What causes kidney stones?

You are more likely to get kidney stones if you:

• Do not drink enough water
• Take certain medicines
• Have certain medical conditions
• Eat too much salt or animal protein
• Have a family history of kidney stones

Signs and symptoms

Small kidney stones may not cause any symptoms and can pass out in the urine without causing pain.

Larger kidney stones may cause:

• Pain in the back or side of the tummy
• Severe pain that comes and goes
• Nausea or vomiting
• Blood in the urine
• Pain or burning while passing urine
• Fever and chills if there is an infection

What treatments should I expect?

Treatment depends on the size and location of the kidney stone.

Treatment options may include:

• Drinking plenty of fluids to help small stones pass naturally
• Medicines to relieve pain or help the stone pass
• Shock wave lithotripsy (SWL): Uses sound waves to break the stone into smaller pieces
• Ureteroscopy: A thin tube is used to remove or break the stone
• Percutaneous nephrolithotomy (PCNL): Removes large or complex kidney stones through a small cut in the back
• Surgery (Open or laparoscopic): Rarely needed if other treatments are not suitable

Large kidney stones are usually treated with PCNL.

Percutaneous Nephrolithotomy (PCNL)

What is PCNL and why is it done?

PCNL is a minimally invasive operation used to remove large or complex kidney stones through a small cut in the back.

It may be recommended when:

• Stones are larger than 2 cm
• Other treatments have not been successful
• Stones are causing blockage, repeated infection or kidney damage

Before the procedure

Before PCNL, your doctor may:

• Check your general health
• Perform blood and urine tests
• Arrange for imaging tests (CT scan, ultrasound or X-ray) to locate the stone
• Review your medicines, especially blood thinners
• Ask about any allergies
• Advise you to stop eating and drinking for several hours before the procedure
• Tell you which medicines you can take with a small sip of water

Procedure

Step-by-step overview

• You will be given general anaesthesia and antibiotics
• A thin tube is passed through the bladder into the kidney
• A small cut (about half an inch or 1 cm) is made in the back
• A narrow track is created into the kidney using X-ray or ultrasound guidance
• A thin tube with a tiny camera (small telescope) is passed through the track to find the stone
• The stone is broken into small pieces using a laser or other special instruments, and the fragments are removed
• A temporary kidney drainage tube may be placed
• The procedure usually takes 1–3 hours
• Hospital stay is usually 1–3 days
• An X-ray or CT scan may be done before discharge to check that the stones have been cleared

After the procedure

After PCNL:

• You will be moved to a recovery room for monitoring
• Your doctor will manage your pain and check your recovery
• A temporary drainage tube may be placed to help urine flow from the kidney
• Most patients stay in hospital for 1–3 days
• It is normal to have a small amount of blood in the urine for a few days
• The removed stone may be sent to a laboratory to help identify its cause and reduce the risk of future stones

Benefits and risks of PCNL

Benefits

• Removes large or complex kidney stones
• High success rate
• Relieves pain and urinary blockage
• Helps protect kidney function
• Minimally invasive, with faster recovery than open surgery

Possible risks

• Bleeding
• Infection
• Injury to the kidney or nearby organs (rare)
• Blood clots
• Temporary blood in the urine
• Need for another procedure if some stone fragments remain

Recovery

• Most people recover within 2–4 weeks
• Avoid heavy lifting and strenuous activities for at least 2 weeks, or as advised by your doctor
• Drink plenty of fluids unless your doctor advises otherwise
• You can usually return to work or school after about 1 week
• If your job involves heavy physical work, you may need 2 weeks or longer
• Attend follow-up appointments to check your recovery and ensure all stones have been removed

Follow-up

• A follow-up visit is usually scheduled 4–6 weeks after the procedure.
• Your doctor may arrange an X-ray, ultrasound or CT scan to check that all the stones have been removed.

When should I contact my doctor?

Contact your doctor immediately if you have:

• Fever or chills
• Heavy bleeding or large blood clots in the urine
• Severe or worsening pain
• Redness, swelling or discharge from the wound
• Difficulty passing urine

Myths and facts

Myth 1: All kidney stones need surgery. Fact: Many small kidney stones can pass naturally or be treated with medicines or other less invasive procedures.

Myth 2: PCNL is open kidney surgery. Fact: PCNL is a minimally invasive procedure performed through a small cut in the back.

Myth 3: PCNL is only used for very painful stones. Fact: PCNL is mainly recommended for large or complex kidney stones, or stones causing blockage, infection or kidney damage.

Myth 4: Once a kidney stone is removed, it will never come back. Fact: Kidney stones can recur. Drinking enough water and following your doctor's advice may help reduce the risk.

Myth 5: Recovery after PCNL takes several months. Fact: Most people recover within 2–4 weeks and gradually return to their normal activities.

References

1. Cleveland Clinic. Kidney Stones. [Online] Available from: https://my.clevelandclinic.org/health/diseases/15604-kidney-stones. Accessed on: 14 July 2026.
2. National Health Service. Kidney stones. [Online] Available from: https://www.nhs.uk/conditions/kidney-stones/. Accessed on: 14 July 2026.
3. British Association of Urological Surgeons. Percutaneous Nephrolithotomy. [Online] Available from: https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/PCNL.pdf. Accessed on: 14 July 2026.
4. Cleveland Clinic. Percutaneous Nephrolithotomy. [Online] Available from: https://my.clevelandclinic.org/health/treatments/17349-percutaneous-nephrolithotomy. Accessed on: 14 July 2026.