Percutaneous Nephrolithotomy is a procedure used to remove kidney stones from the body when they can’t pass on their own. This is mostly used for larger stones or when other procedures, such as extracorporeal shock wave lithotripsy or ureteroscopy are unsuccessful or not possible.
Initially cystoscopy is done. This involves passage of a thin, lighted, telescope through your urine passage, to see inside of the urethra and the bladder. Then a fine (ureteric) catheter is passed by the side of the stone into the kidney. This is used to inject contrast to visualize the details of the kidney during the PCNL.
Depending on the stone, renal anatomy and patient characterizes, your doctor may decide to do supine or prone PCNL. In supine PCNL, you will be lying on the back with little tilt to the other side, whereas in prone PCNL you will be lying on the stomach. In both the techniques, a 1 cm incision is made in the back, over the region of the kidney. Through this small incision, a track is made into the kidney to reach the stone. The entire process is guided by x-ray images. Whether it will be one single incision or more than one, depends upon the number of stones, their position, and the anatomy of the kidney itself. Once a track is established, an endoscope is passed into this track, and into the kidney to visualize the stone and remove it. Stones are broken by different methods. If the track is very small, stones are broken by laser.
Once the procedure is completed, a tube is left through this tract, as drainage, for one or two days.