Percutaneous nephrolithotomy or PCNL is a minimally invasive inpatient procedure performed under general anesthesia to remove kidney stones. Generally, these stones are large and complex. For the PCNL procedure, a small incision is made in the flank (side of the back), underneath the rib cage. Through that incision, the urologist uses scopes to go directly into the kidney, locate the kidney stone, and then break it up using an energy device such as a laser or ultrasound.
Usually, a temporary device (ureteral stent or nephrostomy tube) for urinary drainage is needed after a PCNL. A stent in internal and goes from the kidney to the bladder while a nephrostomy tube directly drains urine from the kidney to an external bag.
Children’s Hospital of Philadelphia’s Pediatric Kidney Stone Center offers the PCNL procedure to remove kidney stones. The procedure is typically done with a short inpatient stay of one to a few days, during which time the patient is monitored for any signs of fever which can occur if the stone is due to infection. The nephrostomy tube is removed a few days after the procedure, once the urine is flowing down in to the bladder.
It's essential to have an experienced, comprehensive, integrated team for kidney stone care. The team at CHOP’s Kidney Stone Center believes in partnering with patients and their caregivers to determine which surgery is best. The team explains the treatment options — including the likelihood of each completely clearing the stone and the surgical and postsurgical experience — and then partners with families to help them make the most informed decision possible.
In addition to removing existing stones, the center’s team tries to prevent future kidney stones. Patients return for follow-up every six months for metabolic testing and an ultrasound to help the team understand what factors are driving stone formation. Once specific risk factors for kidney stone recurrence are identified, the team partners with families to create a long-term prevention plan that works best for them and their child.
The center team is involved in ongoing research efforts dedicated to better understanding why kidney stones are occurring earlier in life and the factors that lead to kidney stones in children. Their hope is to develop better methods to prevent stones from being a recurring disease over a lifespan and improve treatment options for children with kidney stones.