Percutaneous

nephrolithotomy

Percutaneous nephrolithotomy (PCNL) is

a minimally-invasive procedure to remove
stones from the kidney by a small
puncture wound (up to about 1 cm)
through the skin. It is most suitable to
remove stones of more than 2 cm in size
and which are present near the pelvic
region. It is usually done under general
anesthesia or spinal anesthesia.
 Percutaneous nephrolithotomy
Specialty nephrology

[edit on Wikidata]

Procedure
A retrograde pyelogram is done to locate
the stone in the kidney. With a small 1
centimeter incision in the loin, the
percutaneous nephrolithotomy (PCN)
needle is passed into the pelvis of the
kidney. The position of the needle is
confirmed by fluoroscopy. A guide wire is
passed through the needle into the pelvis.
The needle is then withdrawn with the
guide wire still inside the pelvis. Over the
guide wire the dilators are passed and a
working sheath is introduced. A
nephroscope is then passed inside and
small stones taken out. In case the stone
is big it may first have to be crushed using
ultrasound probes and then the stone
fragments removed.[1]

The most difficult portion of the procedure

is creating the tract between the kidney
and the flank skin. Most of the time this is
achieved by advancing a needle from the
flank skin into the kidney, known as the
'antegrade' technique. A 'retrograde'
technique has recently been updated
wherein a thin wire is passed from inside
the kidney to outside the flank with the aid
of a flexible ureteroscope. This technique
may reduce radiation exposure for patient
and surgeon.[2]

Complications
The following complications[1] may take
place:

Injury to the colon

Injury to the lungs
Injury to the renal blood vessels
Urinary leak may persist for a few days
Infection and sepsis
 Hydrothorax if PCNL is done through
11th intercostal space
Bleeding
Death

Notes and references

1. Dr. Rajgopal Shenoy K (2006). Manipal
Manual of Surgery (Second ed.). New Delhi:
CBS Publishers & Distributors. ISBN 978-
8123912370. OCLC 963208918 .
OL 13132970M .
2. Wynberg, Jason B.; Borin, James F.; Vicena,
Joshua Z.; Hannosh, Vincent; Salmon, Scott
A. (Oct 2012). "Flexible ureteroscopy-
directed retrograde nephrostomy for
percutaneous nephrolithotomy: description
 of a technique". Journal of Endourology. 26
(10): 1268–74.
doi:10.1089/end.2012.0160 .
PMID 22563900 .

Patil, Ashish V. (May 2010). "A Novel 5-

Part Percutaneous Access Needle With
Glidewire Technique (5-PANG) for
Percutaneous Nephrolithotomy: Our
Initial Experience". Urology. 75 (5):
1206–1208.
doi:10.1016/j.urology.2009.11.027 .
PMID 20138340 .

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