Percutaneous nephrolithotomy (PCNL) is the gold standard treatment option for patients with large or multiple stones (>2cm), or stones filling the entire kidney (staghorn calculus).
Percutaneous nephrolithotomy is performed under general anesthesia through a small incision in the back. A lighted telescope (nephroscope) is used to see the stone. Through a sheath, ultrasound, mechanical and/or laser energy is used to break the stone into small pieces and remove them.
On occasion, more than one access tract or an additional second look procedure may be needed to remove all the stones. At the end of the procedure a ureteral stent and/or nephrostomy tube is placed to drain the kidney. Patients then spend a night in the hospital.
PCNL is more invasive than either ureteroscopy or SWL and therefore carries a higher risk of complications. However for patients with large stone burdens, multiple stones, or stones resistant to other forms of treatment, the benefits of PCNL outweigh the risks.