The experience of having kidney stones can be exasperating and uncomfortable. Medications alongside a healthy lifestyle may aid in passing smaller stones, but larger ones often need medical assistance. Percutaneous Nephrolithotomy (PCNL) is one of the most effective treatments for large or complex kidney stones.
Is PCNL suitable for everyone? In this blog, we’ll explain who should consider it, who might not be the best candidate, and why expert consultation, particularly with a urologist such as Dr. Deepanshu Gupta, is imperative for informed decision-making.
What Is PCNL?
As the name suggests, PCNL refers to Percutaneous Nephrolithotomy. It is defined as the surgical procedure for the removal of large or complex kidney stones. Instead of making a large incision like in open surgery, the doctor makes a small cut in the back to insert a thin tube (nephroscope) that is used to break the stones and remove them.
PCNL has higher success rates compared to other treatments such as Shock Wave Lithotripsy (SWL) or Ureteroscopy (URS) when dealing with larger and harder kidney stones that surpass the limit of non-surgical procedures.
Who Should Consider PCNL?
Patients with kidney stones do not automatically need a PCNL bladder procedure. There are various factors that need to be addressed prior to concluding if PCNL is the right method of treatment. You might need to undergo PCNL if you fulfill the following requirements:-
1. Big Kidney Stones (More Than 2 cm)
Patients suffering from kidney stones need to receive PCNL only when stones larger than 2 centimeters in diameter are formed within the kidney. Smaller stones present in the kidney can easily undergo a non-invasive procedure called shock wave lithotripsy. Stones larger than this size will tend to cause complications and are best treated via surgical removal.
2. Stones that are Harder to Access
Challenging stones to remove from the kidney that lie deep in the organ, such as in the lower pole, are far more difficult to remove through URS or SWL methods. Removal via other methods is not ideal; hence PCNL provides direct removal to such stones and is more effective.
3. Staghorn Kidney Stones
Certain kidney stones have the tendency to grow and branch out to form large structures, this growth is referred to as a staghorn stone. The creation of these stones can hinder the ability to urinate smoothly and heavily damage the body. The best method of treating these stones is through PCNL, where removal will be possible without leaving any traces.
4. Recurrent or Multiple Kidney Stones
The availability of multiple stones is less common, but PCNL has shown to best deal with these cases, same with patients who icy stones persistently regardless of treatment changes.
5. Stones That Remained Intact After Other Treatment Approaches
For patients where stone extraction did not occur post shock wave therapy (SWL) or ureteroscopy (URS), PCNL may be the most appropriate next step for complete stone removal.
6. Severe Symptoms And Urinary Retention
In the instance that your kidney stones are causing:
- Unbearably severe pain
- Frequent urinary tract infections
- Hemorrhagic cystitis
- Urinary retention
Then, PCNL is the optimal choice to alleviate symptoms and remove the stone.
7. Specific Tissues Stones
Certain stones that withstand non invasive procedures include:
- Cystine stones
- Calcium oxalate monohydrate stones
- Struvite stones
These types of stones, which are known to withstand non intrusive methods to the body, are best treated with PCNL due to its invasive nature.
8. Overweight Or Obese Patients
Obese or overweight patients tend to not lose weight due to the lack of response to shock wave lithotripsy (SWL), as the added tissue around the stone impedes the access sound waves have to the stone. Such patients would benefit more from PCNL because it affords direct access to the stone.
Who Should Avoid PCNL?
Though PCNL is a safe procedure, it is not free from risks. These patients may not be ideal candidates:-
- Women Who Are Pregnant: Given that the patient is not provided any alternatives pregnancy PCNL is ruled out.
- Patients with Uncontrolled Bleeding Disorders: Patients who are hemophiliac or brittle bone patients are more prone to suffer from bleeding so a PCNL can be challenging for them.
- People With Active Urinary Tract Infection: There is need to treat UTI first before proceeding with PCNL since the infection can be reason of complications further down the line.
- People who cannot tolerate Anesthesia: Patients who have severe heart, lung or neurologic issues can be candidate for general or spinal anesthetic PCNL procedure, therefore may not be suitable candidate.
What Steps Are Involved In PCNL?
1. Pre-Surgery Preparation
Prior to your procedure, your physician will:-
- Use imaging techniques such as CT scans, ultrasounds or even X-rays in order to assist you in locating the required stone.
- Conduct a Check Up Of Your Medical History Along With Your MD Previous Medication List
- Inquire whether you are taking any medicines such as anti-coagulants and encourage you to stop using those medications at least 12 hours prior to the procedure.
2. Procedure Steps
- The first step is preparing the patient by administering the required anesthetics.
- An opening (approximately 1 cm in length) is made in the back for the placement of a narrow tube.
- A miniature camera referred to as a nephroscope is employed to find and shatter the stone.
- The stone fragments are completely removed through suction.
3. After PCNL Recovery
- A small drain may be kept in place for one to two days.
- The majority of patients remain hospitalized for one to two days.
- Usual activities can be performed in one to two weeks.
Why Choose PCNL Over Other Kidney Stone Treatments?
| Treatment | Best For | Limitations |
| Shock Wave Lithotripsy (SWL) | Small stones (<2 cm) | May not work for large or hard stones |
| Ureteroscopy (URS) | Mid-sized stones in the ureter | May require multiple sessions |
| PCNL | Large, complex stones (>2 cm) | Requires anesthesia & short hospital stay |
| Open Surgery | Extremely large stones with kidney abnormalities | More invasive & longer recovery |
PCNL has a success rate of 90-95% for large kidney stones, making it the most effective treatment when other methods fail.
Conclusion: For professional guidance regarding treatment with PCNL, contact Dr. Deepanshu Gupta.
Individuals suffering from large kidney stones and seeking a remedy may consider PCNL as a potential solution. However, it is essential to undergo a thorough evaluation by an experienced urologist before making a definitive decision.
Dr. Deepanshu Gupta is noted as an advanced urological surgeon and kidney stone surgeon who has developed particular expertise in the management of complex kidney stones using PCNL, laser stone surgery, and other minimally invasive techniques.
Why choose Dr. Deepanshu Gupta?
✔ Specialized in high-complexity stone procedures.
✔ Successful PCNL outcome rates.
✔ Individualized approaches per patient.
Consultations for expert treatment planning can be scheduled with Dr. Deepanshu Gupta, who ensures best practices and proven methods for all patients who are currently dealing with or have a history of struggled with kidney stones.
Start your journey towards a life without pain!