PCNL (Percutaneous Nephrolithotomy)
Gold-standard minimally invasive removal of large and complex kidney stones through a small back puncture — single session, >95% stone-free rate, for stones beyond the reach of endoscopy.
What is PCNL (Percutaneous Nephrolithotomy)?
Percutaneous Nephrolithotomy (PCNL) is the gold-standard procedure for large, complex, or staghorn renal stones. A small puncture is made in the back under fluoroscopic and ultrasound guidance to create a working tract into the kidney. A nephroscope is passed through this tract and the stone is fragmented using pneumatic, ultrasonic, or holmium laser energy and removed under direct vision. PCNL achieves stone-free rates exceeding 95% for stones larger than 2 cm in a single session — the highest clearance rate available for large stone burdens by any currently available technique.
How the Procedure Works
Positioning & Access
Patient positioned prone; a fine needle is advanced under ultrasound and fluoroscopic guidance into the target calyx of the collecting system.
Tract Creation
A guidewire is coiled in the renal pelvis; sequential dilators enlarge the tract to 24–30 Fr; an Amplatz sheath maintains working access.
Nephroscopy
A rigid nephroscope is introduced through the sheath; the stone is visualised under direct vision before fragmentation begins.
Stone Fragmentation
Pneumatic, ultrasonic, or laser energy systematically fragments the stone; pieces are aspirated or retrieved with forceps simultaneously.
Drainage & Closure
Complete clearance confirmed by fluoroscopy; nephrostomy tube placed for drainage; skin entry requires only one suture or adhesive strip.
Outcomes
Who Needs This Treatment?
- →Patients with renal stones larger than 2 cm where URSL and RIRS cannot achieve single-session clearance.
- →Those with staghorn calculi filling the entire renal collecting system requiring direct percutaneous access.
- →Patients who have failed two or more shockwave lithotripsy sessions for large or lower-pole stones.
- →Those with anatomical abnormalities — horseshoe kidney, calyceal diverticulum — requiring direct renal access.
- →Patients with obstructed kidneys from large stones causing progressive renal function deterioration.
- →Those needing the highest single-session stone-free rate to avoid multiple procedures and anaesthetics.
"PCNL remains our most powerful tool for large and complex stone disease. Modern miniaturised techniques have dramatically reduced morbidity while maintaining the exceptional stone-free rates this procedure has been known for over four decades."
— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon
Common Questions
Frequently Asked
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