Percutaneous nephrolithotomy

Case contributed by Andrew Murphy


Percutaneous nephrolithotomy for removal of kidney stones

Patient Data

Age: 45 years
Gender: Female

Pre operative imaging

Multiple calculi in the left kidney, centered on the renal pelvis.

No ureteric calculi.


Intraoperative imaging

Intraoperative imaging illustrating the steps of a nephrolithotomy procedure.

  1. insertion of the percutaneous nephrolithotomy needle
  2. insertion of the guide wire
  3. insertion of the dilator
  4. insertion of the working sheath

On the lower pole puncture images, prior to scope insertion, the large pelvis stone is shown as a filling defect.


Post operative study

Percutaneous drainage tube overlies the left side of the abdomen.

Renal calculi are not perceptible on plain radiography due to marked overlying fecal residue and bowel shadows which obscure the kidneys.


Post operative study

Post left PCNL

Tiny 2 mm residual calcific fragment within a lower pole calyx.

The large pelvis stones are no longer evident. Left hydronephrosis and perinephric stranding likely secondary to treated obstruction.

Case Discussion

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.

This case is to illustrate the typical imaging pathway of a percutaneous nephrolithotomy, including the images intra-operatively.

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Case information

rID: 48222
Published: 27th Sep 2016
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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