Percutaneous Nephrolithotomy
Percutaneous Nephrolithotomy (PCNL) is done to remove large (greater than 2 cm) kidney stones or staghorn stones through the skin. The doctor makes a small incision in your back. A thin wire is placed through the incision and goes into the kidney and down the ureter (urine tube that goes from the kidney to your bladder). An X-ray helps your doctor guide the wire. A tube is then passed into the kidney to make a larger tract. A viewing scope is put into the kidney. The stone is broken into pieces with sound waves and taken out.
A small hollow tube (nephrostomy tube) is left in the tract for 12 – 36 hours. Sometimes the doctor needs to remove more stones during a “second look”. You will be in the hospital 1-4 days. Most people go home with no tubes in place.
A small hollow tube (nephrostomy tube) is left in the tract for 12 – 36 hours. Sometimes the doctor needs to remove more stones during a “second look”. You will be in the hospital 1-4 days. Most people go home with no tubes in place.
In rare cases, you may have bleeding and need a blood transfusion. There is also a rare chance you could get a lung injury, causing a collapsed lung. This prevents your lung from expanding properly when you try to breathe in, causing shortness of breath and chest pain.
After Surgery
You may leak urine from the wound for 2-3 days. It is normal for the drainage to be slightly bloody or pink in color.
You may need gauze on the site for a few days. Keep it on for 24 hours. Remove it before taking a shower. Replace as needed.
If you have a stent (a tube from the kidney to the bladder to keep the urine flowing) you may:
- Have burning when you pass urine
- Have a strong urge to pass urine
- Pass urine more often
The stent may be taken out at your follow-up clinic visit.
Passing blood in your urine is common. This will clear up by drinking 8-10 (8 oz.) glasses of fluid each day.
Diet
Eat a balanced diet. Drink at least 8-10 (8 oz) glasses of fluid daily. If you get up several times at night to pass urine, you may want to decrease your fluid intake after dinner.
Activity
- You may shower.
- Nothing strenuous until it is okayed by your doctor. Climbing stairs and walking are okay.
- No intercourse for 1 week.
- Do not drive for 1 week or while you are taking narcotic pain medicine.
- Do not lift more than 10 pounds for the first 2 weeks.
- Your doctor will let you know when you can go back to work. You may need to be off for 2 weeks.
Medicine
If antibiotics are ordered be sure to take them all. Pain pills will be ordered. Your pharmacist will instruct you on how to take them.
When to Call the Doctor
- Temperature (by mouth) over 100.5° F for two readings 4 hours apart
- Blood in your urine that does not clear when you drink 8-10 (8 oz.) glasses of fluid daily
- Large blood clots in your urine
- Urine from your back wound more than 3 days after you go home
- Redness, swelling, or tenderness from the wound that is getting worse
- Pus-like drainage
- Decreased urine output
- Pain not controlled by medicine.
Phone Numbers
Urology Clinic: (608) 263-4757.
After hours, weekends, and holidays this will give you the paging operator. Ask for the urology doctor on call. Leave your name and phone number with the area code. The doctor will call you back. You may call paging directly at (608) 262-0486.
If you live out of the area, call 1-800-323-8942.
Your urology doctor is _____________________________________
Your Percutaneous Nephrolithotomy Checklist
Before Surgery
- Visit with surgeon in clinic
- Meet with the surgery scheduler
- Set date for surgery
- Set date to meet with Nurse Practitioner for presurgery physical
- Presurgery physical with Nurse Practitioner (To be done within 30 days of surgery). Please bring copies of recent labs, EKG, CXR, stress test or other heart tests if any. Patient will meet with the following as needed:
- Blood lab, X-Ray, EKG
- Anesthesia Screening Clinic
- Admissions
- May need more tests before surgery, per Nurse Practitioner
- Antibiotics 2 weeks before surgery, per Nurse Practitioner
- Review of typical hospital stay, per Nurse Practitioner
Day of Surgery
- Arrive and check in at First Day Surgery (FDS) Unit on 3rd floor of hospital
- Catheters are placed, ureteral & Foley in the urology Clinic
- Access into kidney using X-ray to guide
- To operating room for stone removal
After Surgery
- CAT Scan on first day after surgery
- Second look or downsize nephrostomy tube on second day after surgery
- Discharge to home or hotel on second or third day after surgery with antibiotics and pain pills
- Return clinic visit in 1 week for evaluation, nephrostomy tube removal and/or stent removal if any
- Return clinic visit in 1 month for further follow-up and ultrasound, per surgeon.
- Return clinic visit in 3 months for further follow-up, per surgeon.
The Spanish version of this Health Facts for You is #7036.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 05/14/2010
Copyright © 07/03/2009 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5077
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