Percutaneous nephrolithotomy

Last revised by Andrew Murphy on 23 Mar 2023

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.

PCNL is used to destroy and remove renal calculi, typically over 2 cm in size and for staghorn calculi.

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

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

It was first performed in 1976.

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Cases and figures

  • Case 1: percutaneous nephrolithotomy
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  • Case 2
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