Percutaneous Nephrolithotomy (PNL)

Percutaneous nephrolithotomy is used to remove kidney stones 2 cubic centimeters or larger (2 cubic centimeters is a little larger than a marble). In PNL, the urologist breaks up and removes the kidney stone through a small incision in the side using a nephroscope. A nephroscope is a telescope about the diameter of a person's pinkie finger used to examine and perform procedures on the kidneys. This procedure is approximately 95 percent effective at removing kidney stones when performed at hospitals experienced with it.

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The procedure begins with a radiologist inserting a narrow guide wire, also known as a catheter, through a small incision (2 to 3 mm long, less than 1/₈ of an inch) in the skin. The catheter is inserted using fluoroscopy, a specialized X-ray technique, to help guide the catheter through the kidney into the ureter while the patient is sedated. Once the guide wire is in place, the patient is moved into the operating room where the PNL procedure is completed under general anesthesia. Dilators are inserted along the guide wire to gradually enlarge the opening so it can accommodate the nephroscope. The urologist inserts the nephroscope, which is equipped with a fiber-optic light, to visualize the stone. All stones and fragments are removed through the nephroscope during the procedure, which usually takes about 15 to 45 minutes; none are left to pass through the urinary tract. If necessary, an ultrasonic probe or laser can be inserted through the nephroscope to break up the stone. A catheter is left in place for several days following the procedure to drain the kidney.

This procedure usually involves one to two days of hospitalization. During this time, additional imaging may be performed to confirm that the stones have been removed. If any stones remain, a nephroscope will be used to remove them; the procedure requires sedation only at this time. Once the stones have been removed, the catheter will be removed and the patient will be discharged from the hospital. Full recovery usually requires one to two weeks.