17349 Percutaneous Nephrolithotomy

Overview

Percutaneous nephrolithotomy (PCNL) is a surgery to remove large kidney stones. 'Percutaneous' means through the skin. The surgeon makes a small cut in your back and puts a thin tube with a camera into your kidney. The stone is broken into smaller pieces and taken out. You will usually have general anesthesia, so you sleep during the procedure.

Kidney stones are common. PCNL is a specialised treatment used when stones are too large or complex for other methods.

Kidney stones can affect anyone, including children, but they are most common in adults. PCNL is usually used in adults with large or complex stones. Your healthcare provider can discuss whether it is suitable for you.

Symptoms

Common symptoms

• Sudden, severe pain in your side and back, often spreading to your lower belly or groin
• Pain that comes in waves and can be very intense
• Blood in your urine, which may look pink, red, or brown
• Feeling sick or being sick
• Pain or a burning feeling when you pass urine
• Needing to pass urine often or urgently
• Cloudy or smelly urine, which may be a sign of infection
• Often no symptoms until the stone moves or blocks urine

Symptoms in children

• Children may have vague tummy or back pain, vomiting, crying, or blood in urine.
• Kidney stones are less common in children, so a doctor should check symptoms.
• A child with fever and pain in the side or back needs urgent medical review.

Symptoms in older adults

• Older adults may not have classic severe pain and may have tiredness, confusion, poor appetite, or urinary changes.
• Fever, confusion, or feeling very unwell with kidney pain needs urgent medical review.
• Ask for help if you are not drinking or passing urine as usual.

Causes

Main causes

• Kidney stones form when waste chemicals in urine become too concentrated and form crystals.
• Not drinking enough fluid is a common reason urine becomes concentrated.
• Some people have higher levels of certain salts or minerals in their urine.
• Urine infections or problems with urine flow can raise the risk.
• Some medical conditions and medicines can increase stone risk; ask your doctor about your own situation.

Risk factors

• Low fluid intake or dehydration
• Previous kidney stones
• Family history of kidney stones
• Obesity
• A diet high in salt or with other patterns linked to your stone type
• Urinary tract infections or blockage
• Some medical conditions and medicines
• Living in a hot climate or working in hot conditions

When to see a doctor

See a doctor urgently if:

• Fever, shaking chills, or feeling very unwell with kidney pain
• Cannot pass urine
• Severe pain or vomiting that will not settle
• Heavy or worsening bleeding in urine
• Wound or stent problems

Book a routine appointment if:

• You have had a kidney stone before and want advice on prevention
• You have blood in your urine, even if it comes and goes
• You have repeated urinary infections
• You are due for follow-up after PCNL
• You have questions about surgery, recovery, or medicines

Diagnosis

Your doctor will ask about your symptoms and medical history, examine you, and arrange tests. If a large stone is found, a urologist (kidney and urinary tract specialist) will decide whether PCNL is suitable.

Tests that may be done

• Blood tests to check kidney function and general health
• Urine tests to look for infection or blood
• CT scan of the kidneys and urinary tract, often without contrast dye
• Ultrasound or X-ray in some cases
• Stone analysis if you have passed a stone or after surgery
• Review of medicines and allergies before surgery

What to expect at your appointment

You may need to fast before surgery. The team will explain the procedure, risks, and consent. You may have a temporary tube or stent after surgery. Most people stay in hospital for a short time, but this varies.

Treatment

PCNL is usually done in a hospital under general anesthesia. The surgeon uses X-ray or ultrasound to guide a thin tube through a small cut in your back into the kidney. The stone is broken into small pieces and removed. You may have a temporary tube or stent to help urine drain. The length of hospital stay depends on your case.

Self-care at home

• Follow your discharge instructions exactly.
• Drink fluids as advised unless your care team tells you to limit them.
• Take pain or infection medicines only as prescribed.
• Keep the wound clean and dry, and follow advice on showering.
• Avoid heavy lifting or strenuous exercise for a few weeks.
• Watch your urine color and amount; some pink urine can be normal, but heavy bleeding needs urgent care.
• Attend follow-up appointments and stent removal if planned.

Medical treatments

Your care team may use medicines for pain, infection, or stone prevention if needed. They will choose what is safe for you. Other stone treatments include shock-wave therapy, ureteroscopy, or watching and waiting for small stones. PCNL is chosen when stones are large or complex.

When is surgery considered?

PCNL may be recommended when a stone is too large to pass, blocks urine, causes infection, damages kidney function, or when other treatments are not suitable. Your specialist will discuss benefits, risks, and alternatives.

Living with this condition

You may go home with a stent or a small tube. Some pink urine, mild discomfort, and tiredness are common at first. Recovery time varies; many people feel better within 1 to 2 weeks but may need longer before heavy activity. Follow your team's instructions about work, driving, and exercise.

Lifestyle tips

• Drink enough fluid to keep urine pale, unless your doctor gives a different target.
• Limit salt and highly processed foods.
• Eat a balanced diet with fruits and vegetables.
• Keep a healthy weight.
• Follow any stone-prevention plan from your care team.
• Avoid dehydration in hot weather or during exercise.

Diet and exercise

Diet changes depend on the stone type. Your team may suggest a balanced diet, less salt, and enough fluid. After you recover, regular exercise is good for overall health. Ask before starting heavy exercise.

Mental health and emotional wellbeing

It is normal to feel anxious before surgery or worried about stones coming back. Talk to your care team if you feel low or overwhelmed. If you have thoughts of harming yourself, contact your local emergency number or a local crisis support service right away.

Prevention

PCNL removes current stones, but it does not stop new stones from forming. Many people can lower their risk by drinking enough fluid, limiting salt, and following their care team's advice based on the stone type.

Vaccines

There is no vaccine for kidney stones. Ask your healthcare provider about any vaccines that are right for you.

Screening programmes

There is no routine screening for kidney stones in the general population. If you have had stones or are at high risk, your doctor may arrange check-ups or tests.

Complications

If left untreated

• Stones can grow larger and block urine flow.
• Blockage can cause severe pain and kidney damage.
• Infected blocked urine can lead to serious infection.
• Repeated stones can cause long-term kidney problems.

Long-term outlook

Most people do well after PCNL. It is a common and effective way to remove large kidney stones. Some people need more than one procedure, and stones can come back. Regular follow-up and prevention steps can help protect your kidneys.

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