Percutaneous nephrolithotomy (PCNL) is a surgical procedure for the extraction of large renal calculi. It is usually performed in the operating theater either by a urologist or combined urologist-radiologist team.
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Indication
PCNL is used to destroy and remove renal calculi, typically over 2 cm in size and for staghorn calculi.
Procedure
PCNL is usually performed with the patient in prone position through a posterior calyx. Supine position can also be used, although, much less commonly perhaps due to lack of much experience and also risk of organ injury. Some of the potential advantages of supine position include:
easier patient positioning
ability to perform simultaneous PCNL and ureteroscopic procedures
better control of the airway
Complications
PCNL can be regarded as an acceptably low morbidity procedure. Some complications include:
hemorrhage
perforation of the collecting system followed by urine extravasation caused by a guide wire with straight and hard tip; it can be avoided to a large extent by using J-wire with soft and curved tip
sepsis
colonic perforation, rare (0.5%)
ureteral stone
vascular injury
pneumothorax
History and etymology
It was first performed in 1976.