What Is Nephrolithotomy for Kidney Stones?

If you have kidney stones that are too big to pee out, surgery may be an option. One type is nephrolithotomy.

With this surgery, your doctor uses a small scope, along with instruments to pluck or vacuum the stones, through a small cut in your back. It’s sometimes also called percutaneous (through-the-skin) nephrolithotomy or stone extraction.

Why You Might Need It

If your stone is unusually large, your doctor may not be able to get it out through other surgeries that use shockwaves or lasers. Nephrolithotomy may be a good alternative if:

  • Your stone is about 4/5 of an inch in diameter (the size of a nickel) or bigger
  • You have a lot of them, or they’re very dense
  • You have branched stones called staghorn that block a large part of your kidneys
  • You’ve had other treatments without success

You’ll usually need to stay in the hospital at least overnight. Nephrolithotomy can completely remove your stones about 85%-90% of the time. You might not be a good candidate for the surgery if you have a severe heart or lung condition, or are prone to uncontrolled bleeding.

Surgery

Before the procedure, your doctor will test your urine and blood for infection. You’ll also have a CT scan, ultrasound, or X-ray so she can see exactly where the stones are.

The surgery usually lasts an hour or two. You’ll lie face-down on a surgical table. You’ll have general anesthesia, so you won’t be awake or feel any pain. Your doctor will inject your bladder with a dye or carbon dioxide so she can “map” the branches of your kidney through a scope.

She’ll then make a small cut midway down your back on the side with the stones. She’ll insert a fiber-optic camera to peer in. She’ll either remove the stones, or she'll use a laser, ultrasonic, or mechanical device to break them up first. When your stones are crushed before removal, it’s called nephrolithotripsy.

You may leave surgery with a small stent that keeps the tube between the kidney and the bladder open to help with urine drainage. You may also have a tube coming from your incision that helps drain fluid from your kidney to a bag attached to the outside of your body. Your doctor will remove it after 1-2 weeks.

You’ll usually need to stay in the hospital for 1-2 days. You may be able to go back to work about a week after. But you’ll have to avoid heavy lifting or pulling for up to a month.

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Risks

As with most surgeries, you can have complications after your nephrolithotomy. But problems are uncommon.

Bleeding. Rarely, you might lose enough blood to require a blood transfusion. For about a week before the surgery, your doctor likely will ask you to avoid any drugs that might make it harder for your blood to clot. They include ibuprofen, aspirin, antacids, vitamin E, blood thinners, and some arthritis medications.

Infection. Signs include a fever, drainage from the incision on your back, pain when you pee, or having to go to the bathroom a lot.

Tissue or organ injury. It’s uncommon, but the surgery could damage organs near the kidney, like your bowel, blood vessels, spleen, and liver. The ureter, which passes urine from the kidney to the bladder, could get punctured. That may lead to scarring or repair surgery.

Nephrolithotomy is the gold standard for removing oversized or complex stones. But it doesn’t always work. If so, you and your doctor can explore other options, like open surgery that requires a larger cut on your body.

WebMD Medical Reference Reviewed by Neha Pathak, MD on September 20, 2017

Sources

SOURCES:

National Kidney Foundation: “Percutaneous Nephrolithotomy/Nephrolithotripsy.”

University of Florida College of Medicine, Department of Urology: “Percutaneous Nephrolithotomy (PCNL).”

Mayo Clinic: “Percutaneous nephrolithotomy,” “Minimally invasive surgery.”

University of California, San Diego Health: “Percutaneous Nephrolithotomy.”

Cleveland Clinic: “Percutaneous Nephrolithotomy.”

Johns Hopkins Medicine: “Percutaneous Nephrolithotomy,” “Percutaneous Nephrolithotomy Pre- and Postoperative Instructions.”

Washington University School of Medicine: “Surgery for Kidney Stones.”

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