Percutaneous nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery to remove kidney stones that are too large, hard, or complex to pass on their own. During this treatment, a surgeon reaches the kidney through a small incision in the back and removes the stone, sometimes after breaking it into smaller pieces. PCNL is often recommended when other treatments haven’t worked or aren’t likely to clear the stone completely.

At Penn Medicine, our urinary stones care specialists include urology surgeons who have advanced training in this specific procedure. We’re among the few centers across Pennsylvania and New Jersey that perform percutaneous nephrolithotomy for kidney stones.

Your care provider may suggest percutaneous nephrolithotomy if kidney stones are causing a blockage or if other methods, like shock wave lithotripsy or ureteroscopy, haven’t worked or aren’t likely to be effective.

PCNL is often used when stones are larger than two centimeters, very hard, irregular in shape, or difficult to reach. It may also be an option when stones involve multiple areas of the kidney or are unlikely to pass on their own.

Percutaneous nephrolithotomy is usually done in the hospital under general anesthesia, so you’ll be asleep and won’t feel pain during the procedure. In most cases, you’ll lie on your stomach so the surgeon can easily reach your kidney through your back. They’ll make a small opening and guide a narrow tube into the kidney using imaging. Small instruments and a camera are passed through that tube to find the stone and remove it.

If the stone is very large, the surgeon may first break it into smaller pieces with a laser, ultrasound, or another device before removing it. Once the stones are broken up, they are suctioned out or removed with special tools. In some cases, a small drainage tube or a stent is left in place for a few days to help your kidney heal and drain urine. The procedure usually takes about three to four hours, though timing can vary based on the size and location of the stone.

Percutaneous nephrolithotomy recovery is different for everyone, though many people stay in the hospital for one to two days. It’s common to have mild soreness and some blood in the urine for a short time after surgery. Your care team will help manage pain, monitor healing, and let you know when it’s safe to go home.

You can usually return to work after about a week, but you should avoid heavy lifting or hard exercise for two to four weeks to let your kidney fully heal. Follow up visits, imaging, or lab testing may also be part of recovery to check for any remaining stone pieces and help prevent future stones.

Many kidney stones pass on their own, but when they don’t, percutaneous nephrolithotomy is often the preferred treatment for larger or more complex cases. At Penn Medicine, urologic surgeons with advanced training perform a high volume of PCNL procedures each year. Care is focused on complete stone removal, smoother recovery, and helping you return to daily life as soon as possible.