Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large, complex or treatment-resistant kidney stones that are unlikely to pass on their own or respond to less invasive treatments. Houston Methodist urologists evaluate the size, location and type of your stone to recommend the treatment that best fits your condition and goals.

 

At Houston Methodist, surgery is not the first step for most kidney stones. Our urology specialists begin with non-surgical treatment whenever possible and recommend a procedure only when more conservative options are unlikely to work or have not provided relief.

What Is Percutaneous Nephrolithotomy?

PCNL is a minimally invasive surgery in which a small incision is made in the back to give your surgeon direct access to the kidney and the stone. A nephroscope is then used to locate and remove large or complex kidney stones.

 

At Houston Methodist, PCNL is typically recommended for stones that are too large, complex or extensive to be effectively treated with ureteroscopy or shock wave lithotripsy. Because PCNL provides direct access to the kidney, it is generally more invasive than ureteroscopy and may require a short hospital stay before discharge.

Why Choose Houston Methodist for Kidney Stone Care

When it comes to kidney stone treatment, experience and expertise matter. Houston Methodist’s team of nationally recognized urologist brings together advanced diagnostic tools, the latest minimally invasive surgical techniques and a patient-centered approach to deliver outstanding care. From your initial consultation throughout your recovery, our specialists work closely with you to develop a personalized treatment plan that addresses your needs today and your long-term urological health.

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Nationally Ranked in Urology by U.S. News & World Report

Houston Methodist Hospital has been nationally ranked in Urology by U.S. News & World Report. U.S. News & World Report has also named Houston Methodist Hospital one of the nation's best as a nationally ranked Honor Roll hospital.

 

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How Does PCNL Work?

PCNL is performed under general anesthesia, so you should not feel pain during the procedure. Your surgeon makes a small incision in your back, creates a direct path to the kidney and inserts a nephroscope with a camera to locate the stone.

 

The stone is then broken apart with a laser or ultrasound device and removed. Depending on your needs, a temporary stent or nephrostomy tube may be placed to help urine drain while you heal.

 

Houston Methodist surgeons perform the full range of PCNL techniques, including standard, mini and ultra-mini PCNL, allowing treatment to be tailored to the size, location and complexity of the stone. In some cases, a smaller PCNL approach may be used to limit tissue disruption while still effectively treating the stone.

PCNL Success Rates

PCNL Success Rates

PCNL is one of the most effective treatments for large and complex kidney stones, though outcomes vary based on factors such as stone size, location and anatomy. For many people, success means removing most or all of the stone and reducing the need for additional treatment. In some cases, a follow-up procedure may still be needed to address remaining fragments.

 

PCNL has high stone-free rates and is often one of the most effective treatments for large or complex kidney stones, though some patients may require additional treatment if stone fragments remain. Your doctor will review the approach most appropriate for your stone and explain what to expect before and after treatment.

What Conditions Does PCNL Treat?

PCNL is used to treat kidney stones that cannot be appropriately managed with less invasive approaches. It may be recommended for the following conditions:

Large Kidney Stones
Kidney stones larger than 2 cm are often difficult to treat with less invasive approaches and are commonly managed with PCNL because it allows direct access to the kidney. This direct access often allows surgeons to remove large stones more completely than less invasive approaches.

Complex Renal Stones

Complex renal stones are difficult to treat because of their size, number, composition or location within the kidney. PCNL provides direct access to the kidney, making it particularly useful for stones that are difficult to reach or remove through other approaches.

Staghorn Calculi

Staghorn calculi are large stones that branch into multiple parts of the kidney’s collecting system and often require PCNL because of their size and shape. Because these stones can occupy multiple parts of the kidney, some patients require more than one procedure to achieve complete stone clearance.

Upper Ureteral Stones

Stones in the upper ureter may sometimes be more effectively accessed and removed through a PCNL approach, especially when they are large or have not responded to other treatments.

  • Who Qualifies for Percutaneous Nephrolithotomy?

    Your doctor may recommend PCNL if imaging confirms a large, complex or treatment-resistant kidney stone. PCNL is usually considered when less invasive treatment options have not worked or are unlikely to work.

     

    To determine whether PCNL is right for you, your care team will review the size, location and characteristics of the stone, along with your anatomy and overall health. They will also explain other treatment options and why one approach may be a better fit than another.

  • Preparing for PCNL

    Preparation begins before the procedure. Follow your surgeon’s instructions carefully to support safe surgery and a smoother recovery. Your doctor may recommend steps such as:

     

    • Completing any required pre-op lab work or imaging
    • Stopping blood-thinning medications if your doctor advises it
    • Stopping smoking, vaping or using other tobacco products before surgery
    • Arranging transportation and support at home
    • Setting up a comfortable recovery space at home
    • Following a nutritious, protein-rich diet leading up to surgery
    • Showering with antimicrobial soap before the procedure
    • Clearing walkways and removing trip hazards before returning home
    • Stopping eating or drinking when instructed the night before the procedure

     

    Taking these steps can help support a safer procedure and a smoother recovery.

  • Recovering from PCNL

    Recovery depends on the size and complexity of the stone, the procedure performed and your overall health. While PCNL is minimally invasive, it often requires a short hospital stay, and recovery generally takes longer than with ureteroscopy. Many people begin feeling better within one to two weeks, though returning to normal activities may take several weeks.

     

    During the first day or two after surgery, it is common to feel sore or tired as the anesthesia wears off. You may also notice temporary urinary urgency, mild discomfort or light blood in the urine, especially if a stent or nephrostomy tube has been placed.

     

    Staying well-hydrated, moving gently as advised and keeping follow-up appointments are important parts of recovery. If your job is mostly sedentary, you may be able to return to work after a few weeks. Physically demanding work may require a longer recovery period.

     

    Contact your care team if symptoms feel worse instead of gradually improving or if you have questions about pain, bleeding, urination or recovery. Your doctor will explain what is expected after PCNL and which symptoms may require follow-up.

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