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Percutaneous kidney procedures

Percutaneous nephrostomy; Percutaneous nephrostolithotomy; PCNL; Nephrolithotomy

Percutaneous (through the skin) urinary procedures help drain urine from your kidney and get rid of kidney stones.

Description

A percutaneous nephrostomy is the placement of a small, flexible tube (catheter) through your skin into your kidney to drain your urine. It is inserted through your back or flank.

Percutaneous nephrostolithotomy (or nephrolithotomy) is the passing of a special medical instrument through your skin into your kidney. This is done to remove kidney stones.

Most kidney stones pass out of the body on their own through urine. When they do not, your health care provider may recommend these procedures.

During the procedure, you will lie on your stomach on a table. You will be given a shot of lidocaine in the skin where the procedure will be done. This is the same medicine your dentist uses to numb your mouth. The provider may give you medicines to help you relax and reduce pain.

If you have nephrostomy only:

  • The surgeon inserts a needle into your skin. Then the nephrostomy catheter is passed through the needle into your kidney.
  • You may feel pressure and discomfort when the catheter is inserted.
  • A special type of x-ray is used to make sure the catheter is in the right place.

If you have percutaneous nephrostolithotomy (or nephrolithotomy):

  • You will receive general anesthesia so that you will be asleep and feel no pain.
  • The surgeon makes a small cut (incision) on your back. A needle is passed through the skin into your kidney. Then the tract is dilated and a plastic sheath is left in place allowing a tract to pass instruments.
  • These special instruments are then passed through the sheath. Your surgeon uses these to take out the stone or break it into pieces.
  • After the procedure, a tube is placed in the kidney (nephrostomy tube). Another tube, called a stent, is placed in the ureter to drain urine from your kidney. This allows your kidney to heal.

The place where the nephrostomy catheter was inserted is covered with a dressing. The catheter is connected to a drainage bag.

Why the Procedure Is Performed

Reasons to have a percutaneous nephrostomy or nephrostolithotomy are:

  • Your flow of urine is blocked.
  • You are having a lot of pain, even after being treated for a kidney stone.
  • X-rays show the kidney stone is too large to pass by itself or to be treated by going through the bladder to the kidney.
  • Urine is leaking inside your body.
  • The kidney stone is causing urinary tract infections.
  • The kidney stone is damaging your kidney.
  • Infected urine needs to be drained from the kidney.

Risks

Percutaneous nephrostomy and nephrostolithotomy are generally safe. Ask your surgeon about these possible complications:

  • Pieces of stone left in your body (you may need more treatments)
  • Bleeding around your kidney
  • Problems with kidney function, or kidney(s) that stop working
  • Pieces of the stone blocking urine flow from your kidney, which may cause very bad pain or kidney damage
  • Kidney infection

Before the Procedure

Tell your surgeon or nurse if:

  • You are or could be pregnant
  • You are taking any medicines, including medicines, supplements, or herbs you bought without a prescription
  • You have been drinking a lot of alcohol, more than 1 or 2 drinks a day

Planning for your surgery:

  • If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions.
  • If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
  • If needed, prepare your home to make it easier to recover after the procedure.
  • Ask your surgeon if you need to arrange to have someone drive you home after your procedure.

During the week before your surgery:

  • You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
  • Ask your surgeon which medicines you should still take on the day of the procedure.
  • Let your surgeon know about any illness you may have before your procedure. This includes COVID-19, a cold, flu, fever, herpes breakout, or other illness. If you do get sick, your procedure may need to be postponed.

On the day of surgery:

  • Follow instructions about when to stop eating and drinking.
  • Take the medicines your surgeon told you to take with a small sip of water.
  • Follow instructions on when to arrive at the hospital. Be sure to arrive on time.

After the Procedure

You are taken to the recovery room. You may be able to eat soon if you do not have an upset stomach.

You may be able to go home within 24 hours. If there are problems, your surgeon may keep you in the hospital longer.

The surgeon will take out the tubes if x-rays show that the kidney stones are gone and your kidney has healed. If stones are still there, you may have the same procedure again soon.

Outlook (Prognosis)

Percutaneous nephrostolithotomy or nephrolithotomy almost always helps ease the symptoms of kidney stones. Often, the surgeon is able to remove your kidney stones completely. You sometimes you need to have other procedures to get rid of the stones.

Most people who are treated for kidney stones need to make lifestyle changes so that their bodies do not make new kidney stones. These changes include avoiding certain foods and not taking certain vitamins. Some people also have to take medicines to keep new stones from forming.

Open References

References

Bushinsky DA. Nephrolithiasis. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 111.

Georgescu D, Jecu M, Geavlete PA, Geavlete B. Percutaneous nephrostomy. In: Geavlete PA, ed. Percutaneous Surgery of the Upper Urinary Tract. Cambridge, MA: Elsevier Academic Press; 2016:chap 8.

Leavitt DA, de la Rosette JJMCH, Hoenig DM. Strategies for nonmedical management of upper urinary tract calculi. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 93.

Matlaga BR, Krambeck AE. Surgical management of upper urinary tract calculi. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 94.

Zagoria RJ, Dyer R, Brady C. Interventional genitourinary radiology. In: Zagoria RJ, Dyer R, Brady C, eds. Genitourinary Imaging: The Requisites. 3rd ed. Philadelphia, PA: Elsevier; 2016:chap 10.

 

Review Date: 1/1/2025

Reviewed By: Kelly L. Stratton, MD, FACS, Associate Professor, Department of Urology, University of Oklahoma Health Sciences Center, Oklahoma City, OK. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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