Percutaneous Nephrolithotomy (PCNL)

Percutaneous  Nephrolithotomy (PCNL)
Your doctor may recommend PCNL surgery if you have a large, multiple or complex stones. The surgery lasts one to three hours and typically requires a hospital stay of one to two nights. You should be able to resume normal activities in one to two weeks.

The Procedure

After you are under anesthesia, your doctor makes a small incision in your back and inserts a protective sleeve, or sheath, through your back and into your kidney. The doctor then passes a video scope called a nephroscope through the sheath to locate and remove the kidney stone.
To help your kidney heal and drain urine during recovery, your doctor may place a nephrostomy tube or ureteral stent in your body at the end of the procedure. Some patients require a second surgery to remove any remaining parts of the stone. If so, the nephrostomy tube or stent may be left in place until then.

Before Surgery

Let your doctor know:

  • All of your prescription medicines, vitamins and supplements, herbs and natural remedies, and over-the-counter drugs.
  • Any known allergies you have to medicines and the contrast agent used in some X-rays.
  • If you may be pregnant.

Review the pre-operative directions provided by your doctor. You may need to:

  • Schedule appointments for an electrocardiogram (EKG), X-rays, or blood and urine tests.
  • Discuss with your doctor medicines that might increase your risk of bleeding, such as aspirin, ibuprofen, warfarin, clopidogrel and non-steroidal anti-inflammatory drugs. You may need to stop taking some of these medicines before the procedure.
  • Take antibiotics, if prescribed, to help prevent infection.
  • Check with your doctor on which of your regular medicines to take the morning of surgery. On that day, take these medicines with only a small sip of water.
  • Have nothing to eat or drink after midnight the night before surgery (except the sip of water with your morning medicines).

Arrange for a ride home

You cannot drive yourself home after surgery, so ask a family member or trusted friend to pick you up. Most hospitals and surgery centers will not allow you to take a taxi home after surgery.

After Surgery

Be aware of these common side effects:

  • Nausea and occasional vomiting.
  • Pain within the first 24 to 48 hours in your kidneys, abdomen, lower back and sides. Pain may increase when you urinate. Take medicine as prescribed.
  • Blood in your urine. The color can range from light pink to reddish and sometimes can even have a brownish hue – but you should be able to see through it. (Medications to help with burning sensation during urination can sometimes turn urine orange or blue.) If bleeding increases significantly, call your doctor immediately or go to an emergency room for evaluation.

If you go home with a nephrostomy tube and drainage bag:

  • The nephrostomy tube is a catheter placed in your kidney that connects to a drainage bag to collect urine outside of your body. The tube is usually removed before you leave the hospital, but some patients have it removed at a follow-up appointment, typically two to four days after surgery.
  • Empty the drainage bag before it gets full. If the bag no longer drains urine and you experience back pain, call your doctor immediately. The tube may be blocked or loose.
  • You may notice leakage of urine around the tube and may need to change the dressing.
  • The bag can get wet, so it’s okay to shower. However, you must keep the incision site covered with a waterproof dressing. 

If you go home with a ureteral stent:

  • The ureteral stent is a small plastic tube placed in your urinary tract to help control swelling and allow the kidney to drain urine.
  • Your doctor will remove the stent at a follow-up appointment, typically four to 14 days after surgery, although sometimes the stent must stay in longer.
  • You may experience a feeling of fullness and a constant need to urinate (urgency and frequency), a burning sensation during urination or when you move, and bladder muscle spasms.
Call your doctor immediately if:  •	You have a temperature greater 	than 100 degrees Fahrenheit or  	experience chills. •	The pain medicine is not reducing 	your pain or you are having a side 	effect from pain medication. •	You cannot tolerate food or fluids. •	You have excessive blood in your 	urine – red, thick, unable to see 	through it – or if 	blood clots make it difficult to 	urinate. (Drinking fluids helps reduce the potential for blood clots to form in your urine.)

Download the Patient Brochure

A Patient Guide to Percutaneous Nephrolithotomy

Your Questions Answered

File type: PDF