Percutaneous nephrolithotomy is the most effective surgical method for treating large, hard, complex or staghorn stones, as well as stones in patients with skeletal deformity or severe obesity. These stones are located inside the kidney (nephrolithiasis) and cannot be effectively treated with simple ureteroscopy (laser) or extracorporeal lithotripsy.
Urologist and stone-disease specialist Dr. Angelos Economides performs percutaneous nephrolithotomy (PCNL) & Mini-PCNL even on very large stones, but through a very small incision/opening of just 1 centimetre.
Its advantages over extracorporeal lithotripsy are:
- Greater chances of complete stone removal (almost 100%)
- The possibility of removing the stones within a short period of time
- The possibility of removing the stones in a single session
- Lower cost, as extracorporeal lithotripsy usually requires multiple sessions, resulting in a higher overall treatment cost
Its advantages over open, classic surgery are:
- It often “clears” the kidney of a large volume of stones in a single procedure
- Shorter surgical time, although this depends on the surgeon’s experience
- Minimisation of postoperative pain
- Better cosmetic result, since large, unsightly scars are avoided
- Negligible blood loss
- Faster recovery and quicker patient mobilisation
- Faster discharge from the Clinic
- Faster return to daily activities
- Minimal wound-related postoperative complications
How Percutaneous Nephrolithotomy is Performed
The procedure is performed through a very small incision in the back or flank. The patient is under general anesthesia. With the help of a fluoroscopy machine (C-arm) and ultrasound, the urologist precisely locates the point in the kidney where the stone is situated. A small opening is then created and a special needle is passed directly into the kidney to create an access tract. This tract is gradually dilated so that a thin plastic tube (sheath) can be placed, creating a safe “corridor” from the skin directly into the interior of the kidney.
Through the sheath, a special endoscope called a nephroscope is inserted. Using specialised laser or ultrasonic instruments, the surgeon fragments the stone and simultaneously suctions it out of the body.
After the procedure, depending on the case, a thin temporary kidney catheter (nephrostomy) and/or an internal stent may be placed to support proper healing.
The hospital stay usually lasts 1 to 3 days, depending on the complexity of the stone and the technique used.
Mini-PCNL
In recent years, we have been using much thinner instruments (Mini-PCNL), which drastically reduce the size of the incision, postoperative pain and hospital stay, while maintaining very high success rates in the complete removal of large stones.
