Percutaneous Nephrolithotomy (PNL)
Percutaneous Nephrolithotomy (PNL) is a surgery to remove large stones directly from the kidney. The advantage is that even very large stones are removed in a single operation (Fig. 1a and b). Percutaneous Nephrolithotomy is carried out under general anaesthesia.
Compared to SWL and URS, PNL is more invasive and there is a higher risk of complications. The most common complications areFig. 1a: A nephroscope is used to remove stones directly from the kidney.Fig. 1b: Stone fragments are removed in a single procedure with a nephroscope. bleeding and fever.
When should I consider PNL?
Percutaneous Nephrolithotomy (PNL) should be considered when your stone is very large (bigger than 2 centimetres) and has not moved to the ureter. Your doctor may also discuss Percutaneous Nephrolithotomy as a treatment option if:
- You have more than one stone
- Your stone is very hard
Watch this video to learn more about how PNL is performed
How is PNL performed?
PNL is carried out under general anaesthesia. While you are under anaesthesia, the doctor punctures the kidney with a needle through your skin. The doctor makes the puncture channel large enough to insert the nephroscope. Depending on the size of the stone, it is either removed completely or it is broken into smaller pieces first. Fragmentation of the stone is done with laser, ultrasound, or a pneumatic lithotripter (which works like a little jackhammer). At this point all stone fragments are removed. Sometimes a JJ-stent (Fig. 2) or a percutaneous nephrostomy tube (Fig. 3a and b) is placed to make sure that urine can leave your kidney.
Watch this video to learn more about JJ-stent placement.
When is PNL not recommended?
PNL is a safe and effective procedure but there are some contraindications because the stone is accessed directly through the skin. If you take medication to prevent blood clotting you should stop taking it before the procedure. However, it is always important to discuss your individual situation with the doctor. In addition, PNL is not recommended if you are pregnant or if your physique makes it difficult to access the kidney.
How do I prepare for the procedure?
Your doctor will advise you in detail about how to prepare for the operation. You must not eat, drink, or smoke for 6-8 hours before the procedure to prepare for general anaesthesia.
How long will it take me to get back to my normal daily activities?
After PNL you will stay in the hospital for some days. In the case that you have a percutaneous nephrostomy tube, you will be discharged when the doctor or nurse can remove it. Your urine might be a little bloody for the first couple of days. Do not plan physical exercise the first two weeks after the procedure.
You need to go back to the hospital right away if you:
- Develop a fever
- Feel pain in your kidney or flank
- Still have blood in your urine a week after the surgery
Fig. 3a: A percutaneous nephrostomy tube is used to drain urine directly from the kidney into the catheter bag.
Advantages of PNL
Even very big stones can be removed completely during one single operation
Disadvantages of PNL