pcNL (Percutaneous Nephrolithotomy)
Percutaneous Nephrolithotomy is a minimally invasive surgical method used to remove larger stones from the kidney. This procedure is typically indicated for kidney stones larger than 2 cm, up to complete staghorn stones. Although percutaneous nephrolithotomy is considerably more invasive than ESWL (Extracorporeal Shock Wave Lithotripsy) and URS (Ureterorenoscopy), it is performed through just a small incision in the skin and has completely replaced the much more invasive open stone surgery.
For surgical planning, radiographic examinations (CT and contrast X-rays) are required. Two weeks before admission, surgical clearance must be obtained from a general practitioner or internist. Admission takes place the day before the surgery. You will be thoroughly informed about the procedure and potential complications.
The procedure is always performed under general anesthesia.
I perform the procedure using the so-called “supine” technique. This means the patient does not need to be turned onto their stomach, which significantly eases both the anesthesia and access to the bladder and ureter and shortens the time under anesthesia.
During the surgery, the kidney is punctured with a thin needle, then the puncture channel is dilated to facilitate the insertion of the endoscope. The stone is either immediately removed or first fragmented into small pieces and suctioned out. At the end of the surgery, the renal pelvis and calyces are checked for stone clearance. A ureteral stent, a bladder catheter, and a kidney drain are left in place after the surgery to ensure proper urine passage from the kidney.
The surgery lasts between one and two hours. After the surgery, all patients are initially taken to the recovery room, where their vital parameters are closely monitored until transfer to a regular ward is possible. On the first and second postoperative days, the stents and drains are removed, and the patient is mobilized.
Due to the higher invasiveness (the approach does not utilize a natural body opening), complications following pcNL are more frequent than after URS and ESWL. The most common complications include bleeding and infection with fever.
I perform pcNL at the Landesklinikum Wiener Neustadt. If interested, please schedule an appointment in my practice and bring all findings and X-ray images (CDs) with you.
The most appropriate approach depends on the size, composition, and location of the urinary stones and will be thoroughly discussed with you based on your examination results. Urinary stones should never be neglected. If left untreated, the stones can lead to pathological changes in the kidney or other complications (such as urinary obstruction and rising urine levels) and, in the worst case, lead to kidney failure or blood poisoning (sepsis).
