Percutaneous nephrolithotomy (PCNL)
Keyhole surgery to remove large or complex kidney stones through a small cut in the back, using a telescope passed directly into the kidney.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- PCNL removes large or complex kidney stones through a small cut in the back and gives the best chance of clearing a big stone in one operation.
- It is more invasive than shockwave treatment or ureteroscopy, with a higher chance of bleeding and infection.
- Most people stay in hospital a short time and may have a temporary nephrostomy (drainage) tube and a stent afterwards.
- It treats the stone but does not prevent new ones; a check scan confirms clearance and prevention advice is worthwhile.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
The best chance of clearing a large or complex kidney stone in a single operation
An untreated urine infection is present and should be cleared first, as PCNL carries a real risk of serious infection.
You recover in hospital with painkillers and fluids. Expect blood in the urine and discomfort. A nephrostomy tube and/or stent may be draining the kidney.
Clear instructions on tube and stent care and firm dates for removal.
You recover in hospital with painkillers and fluids. Expect blood in the urine and discomfort. A nephrostomy tube...
A check scan or X-ray assesses how much stone has cleared. Any nephrostomy tube is often removed before you go...
Soreness and tiredness ease at home. Drink plenty of fluids unless told otherwise, avoid heavy lifting and...
Any internal stent is removed in clinic a short time later, usually with a small flexible camera. Stent symptoms...
What is percutaneous nephrolithotomy (PCNL)?
Percutaneous nephrolithotomy (PCNL) is keyhole surgery to remove large or complex kidney stones. The surgeon makes a small cut in the back and passes a telescope directly into the kidney, then breaks up and removes the stone using a laser, ultrasound or pneumatic energy.
It is the usual choice for big stones (often over about 2 cm), 'staghorn' stones that fill the kidney's drainage system, and stones that other treatments such as shockwave or ureteroscopy are unlikely to clear. It gives the highest chance of clearing a large stone in a single operation.
PCNL is more invasive than shockwave treatment or ureteroscopy and carries a higher chance of bleeding and infection, so it is used when the size or complexity of the stone justifies it. It treats the stone you have; it does not stop new stones forming, so the underlying cause still needs looking into. Most people stay in hospital for a short time and may have a temporary drainage tube in the kidney afterwards.
Types & techniques
There isn't one single operation. The right approach depends on you — which is something to discuss with your surgeon.
How PCNL compares for kidney stones
| Treatment | How it works | Best suited to |
|---|---|---|
| PCNL | Telescope through a small cut in the back into the kidney | Large, complex or staghorn kidney stones; best single-operation clearance |
| Ureteroscopy | Telescope up the natural tubes, laser breaks the stone | Ureter stones and many smaller kidney stones; no skin cut |
| Shockwave (ESWL) | Sound waves from outside break the stone | Smaller stones; least invasive, but may need repeating |
PCNL is generally reserved for stones too large or complex for the other methods. Your urologist weighs stone size, position, your anatomy and kidney function.
Preparing for your surgery
- See the operating urologist, who will review your scans and explain why PCNL is recommended over shockwave treatment or ureteroscopy.
- Give a urine sample; an active infection must be treated first, as PCNL carries a real risk of serious infection.
- Have blood tests, including a check of kidney function and a group-and-save in case a transfusion is needed.
- Tell the team about all medicines, especially blood thinners, and agree well in advance which to pause.
- Mention diabetes, a single working kidney, an unusual kidney shape or previous stone surgery, as these affect risk.
- You will fast before the general anaesthetic and should arrange a hospital stay of a few days and help at home afterwards.
- Ask whether you are likely to wake up with a drainage tube in your back and/or an internal stent.
What happens
PCNL is done under general anaesthetic, so you are asleep. Using X-ray or ultrasound for guidance, the surgeon makes a small cut in the back and creates a narrow channel into the kidney. A telescope is passed along this channel to the stone.
The stone is broken into pieces with a laser, ultrasound or pneumatic device and the fragments are removed or suctioned out. Sometimes more than one channel is needed for a large or branching stone. At the end, a drainage tube (nephrostomy) may be left through the skin into the kidney, and/or an internal stent placed between the kidney and bladder, to help drainage while the kidney settles.
Most people stay in hospital for a few days. Expect some blood in the urine and discomfort around the wound and kidney area. A check scan or X-ray is usually done before discharge or shortly after to see how much stone has been cleared.
Is this operation right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- An untreated urine infection is present and should be cleared first, as PCNL carries a real risk of serious infection.
- A bleeding tendency or blood thinners that cannot be safely managed around surgery.
- The stone is small enough to be cleared more safely by shockwave treatment or ureteroscopy.
- Anatomy or position that would make access to the kidney unsafe, where another approach is preferred.
- You are not fit enough for a general anaesthetic and a few days in hospital.
Delay surgery if…
- You currently have a urine infection or unexplained fever.
- You are or might be pregnant, as X-ray guidance and anaesthetic plans change.
- Blood-thinning medication has not yet been reviewed.
- Recent scans, kidney-function blood tests or a group-and-save are not available.
- You cannot arrange the hospital stay or help at home that recovery needs.
Alternatives to discuss
- Ureteroscopy with laser, for smaller kidney stones or as a staged approach.
- Shockwave lithotripsy (ESWL) for suitable smaller stones, sometimes combined with PCNL.
- Watchful monitoring for some stones that are not causing symptoms or blockage, under specialist advice.
- Open or robotic stone surgery in rare, complex cases where keyhole access is not possible.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Anaesthetic choices
The safest option depends on the operation, your health, the facility and your surgeon/anaesthetist. Ask what is planned and why.
Benefits
- The best chance of clearing a large or complex kidney stone in a single operation
- Effective for staghorn stones that fill the kidney's drainage system
- Removes stone that shockwave treatment or ureteroscopy would be unlikely to clear
- Can relieve blockage and protect kidney function from a large obstructing stone
- A faster recovery than traditional open kidney surgery
Risks & complications
- Blood in the urine for several days
- Pain or soreness around the wound and kidney area
- Some fever or feeling off-colour in the first day or two
- Discomfort from a nephrostomy tube or stent if one is left in
- Bleeding heavy enough to need a blood transfusion
- Urine infection or fever needing antibiotics
- Not all the stone being cleared, so a further procedure is needed
- A urine leak from the kidney, sometimes needing the tube or stent left longer
- Serious infection (sepsis) that can make you very unwell
- Injury to nearby organs such as the bowel, lung lining or the chest cavity, very rarely needing further surgery
- Damage to the kidney needing intervention, and very rarely loss of the kidney
- A connection or bleeding problem in the kidney's blood vessels needing a special X-ray procedure to seal it
Because PCNL involves passing instruments directly into the kidney, bleeding and infection are the most important risks and are higher than with shockwave treatment or ureteroscopy. An untreated urine infection beforehand raises the chance of serious infection during surgery. The size and number of access channels affect bleeding risk. Ask your surgeon about their stone-clearance and transfusion rates, whether you are likely to need more than one channel, and the plan if a complication occurs.
Published figures to discuss
Stone clearance is high but complication rates vary with stone size and complexity, the number of access channels, operative time and your own health, especially infection beforehand and diabetes. The figures below are cautious ranges from UK audit data and published series; your own risk depends on your circumstances and your surgeon's experience.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Stone cleared (stone-free) | Commonly around 80–85% in reported series | Lower for very large or staghorn stones, which may need more than one procedure. | PCNL audit of outcomes and complications — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Blood transfusion needed | Often low single digits, but systematic reviews report about 7% overall; higher with large stones, multiple tracts or standard wider tracts | Mini-PCNL tends to involve less bleeding than standard PCNL. | PCNL audit of outcomes and complications — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Fever or urine infection after surgery | Fever is common, around 10–11% in reviews; sepsis is less common but reported roughly 0.3–9.3% | Higher risk with positive urine culture, staghorn stones, diabetes and longer operations. | PCNL audit of outcomes and complications — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Need for a further procedure | Often around 10–20% for complex stones, but strongly dependent on size and whether the stone is branching/staghorn | May be a second-look PCNL or a top-up with shockwave or ureteroscopy. | PCNL audit of outcomes and complications — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Injury to nearby organs (bowel, chest or lung lining) | Rare | Very occasionally needs further treatment; depends on stone position and access. | PCNL audit of outcomes and complications — PMCpmc.ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
Recovery — what to expect, and when
PCNL has a longer recovery than the other stone treatments because there is a wound in the back and instruments pass into the kidney. Most people stay in hospital a few days and feel sore for a couple of weeks.
- Blood-tinged urine for several days
- Soreness around the wound in the back that eases over a week or two
- Tiredness for a while after a longer anaesthetic and hospital stay
- Stent symptoms (urgency, frequency, a kidney twinge) if a stent is left in
- Passing small stone fragments or grit in the urine
Aftercare
- Drink plenty of fluids to keep the urinary system flushing, unless your team advises a limit.
- Take prescribed painkillers and finish any course of antibiotics.
- Keep the wound clean and dry as instructed, and watch for redness, heat or discharge.
- Avoid heavy lifting, straining and vigorous exercise for a few weeks.
- Know the date for stent removal, if a stent was left, and do not miss it.
- Keep your follow-up scan appointment to confirm the stone has cleared.
- Save any passed fragments if asked, so the stone can be analysed.
- Urine checked and any infection treated before surgery
- Blood-thinner plan agreed in advance
- Hospital stay of a few days and help at home arranged
- Painkillers at home
- Stent removal date noted (if applicable)
- Follow-up scan appointment noted
- Clinic contact number for fever or bleeding saved
Scars and how they heal
There is usually one small scar on the back where the telescope entered the kidney; occasionally more than one if several channels were needed. These generally heal to small, discreet marks. Because instruments pass into the kidney, the more important issues are internal — bleeding and infection — rather than the appearance of the skin scar.
⚠ Get urgent help if…
- A high temperature, shivering or feeling very unwell — possible serious infection, seek urgent help
- Heavy or persistent bleeding in the urine, or feeling faint
- Severe pain not controlled by painkillers
- Breathlessness or chest pain (rarely the lung lining can be affected)
- Being unable to pass urine, or passing very little
- Leakage, redness or discharge from the wound in the back
Who to contact: your surgeon or clinic first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result is that most or all of the stone is removed and the kidney drains freely. PCNL gives the highest single-operation clearance for large and complex stones, though some people need a second 'look' or a top-up treatment such as shockwave or ureteroscopy for any remaining fragments. A check scan confirms how much has been cleared.
Clearing the stone treats the current problem but does not change the tendency to form stones. A clear follow-up scan is reassuring, but new stones can still form, so investigating the cause and prevention advice are worthwhile.
Removing a large stone protects the kidney and relieves blockage, but many people who form stones go on to form more over the years, especially after a big or staghorn stone. Investigations into the cause, together with advice on fluids and diet, can lower that risk. Any drainage tube or stent is temporary and must be removed as planned.
Combining with other procedures
PCNL is sometimes combined with ureteroscopy in the same session for stones in both the kidney and the ureter, or staged with shockwave treatment to clear fragments left after surgery. For very large staghorn stones, more than one procedure is often planned from the outset.
Follow-up & long-term care
You will usually have any stent removed within a couple of weeks and a check scan a few weeks later to confirm clearance and good drainage. Many people are then offered tests and advice to reduce the chance of new stones.
- Keep well hydrated day to day, aiming for pale urine, unless advised otherwise.
- Follow any diet advice tailored to the type of stone you formed.
- Attend metabolic tests or stone-analysis appointments if offered.
- Report any return of stone-type pain or fever promptly, as new stones can form.
Revision and secondary surgery reality
- Large or staghorn stones often need more than one procedure, sometimes planned from the start.
- Remaining fragments may be cleared with a second look or a top-up shockwave or ureteroscopy treatment.
- If the ureter or kidney needs to settle, a stent or tube may be left in and removed later.
- Forming one large stone raises the chance of forming others, so further treatments over time are possible.
Ask your surgeon for their own revision rate, what counts as a revision, and what is included in the written aftercare policy.
What good aftercare looks like
- Clear instructions on tube and stent care and firm dates for removal.
- A named contact and urgent route for fever, heavy bleeding or being unable to pass urine.
- A planned check scan to confirm clearance and identify any remaining fragments.
- Referral for stone analysis and prevention advice where appropriate.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Surgeon and anaesthetist fees
- Theatre and facility charges, and a hospital stay of usually a few days
- Energy device used to break the stone (laser, ultrasound or pneumatic) and any disposable instruments
- Complexity: stone size and type, staghorn stones, and whether one or more channels or procedures are needed
- Nephrostomy tube and/or stent, and the cost of stent removal in clinic
- Imaging before and after, follow-up consultations and stone-prevention tests
- The operating surgeon's and anaesthetist's fees
- Theatre, facility and the expected length of hospital stay
- Cost of any stent and its later removal
- Follow-up scan to confirm clearance
- What happens, and what it costs, if a further procedure is needed for remaining stone
- Cancellation policy and cover if a complication such as bleeding or infection arises
On the NHS? PCNL is a standard NHS treatment for large or complex kidney stones; private care is sometimes chosen for faster treatment, choice of timing or a chosen surgeon.
You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Underplaying that PCNL is more invasive, with higher bleeding and infection risk than the gentler treatments.
- Not mentioning the possible need for a blood transfusion or more than one procedure.
- No clear plan or date for removing a nephrostomy tube or stent.
- An over-optimistic single-operation clearance figure for a large or staghorn stone.
- No agreed way to confirm clearance and no prevention advice.
Marketing red flags
- Promising complete clearance of a large stone in one operation regardless of complexity.
- Describing keyhole kidney surgery as without risks or pain-free.
- Not mentioning bleeding, transfusion or infection risk.
- No mention of follow-up imaging or stone-prevention advice.
Choosing a surgeon safely
- Check your surgeon is on the GMC Specialist Register for this area.
- Make sure they practise at a CQC-registered location, and look for membership of bodies like BAAPS or BAPRAS.
- You're entitled to a two-stage consent process with time to reflect (a cooling-off period). The surgeon who will operate must consent you — not a salesperson.
- Be wary of pressure: time-limited offers, discounts or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including aftercare and any revision — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Why is PCNL the right choice for my stone rather than the gentler options?
- What is your stone-clearance rate and how often do patients need a transfusion?
- Am I likely to need more than one channel, or more than one operation?
- Will I wake up with a drainage tube and/or a stent, and when will they come out?
- What are my personal risks, given my kidney function and other conditions?
- What can I do to reduce the chance of forming more stones?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my operation, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this operation not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Why do I need PCNL rather than shockwave or ureteroscopy?
How big is the cut?
Will I need a drainage tube?
What are the main risks?
Will the whole stone be gone?
Is it available on the NHS?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Kidney stones: treatment BAUS — Percutaneous nephrolithotomy (PCNL) patient leaflet NICE NG118 — Renal and ureteric stones: assessment and management PCNL audit of outcomes and complications — PMC Mini-PCNL versus standard PCNL: efficacy and safety pooled analysis — PMC Standardizing the reporting of PCNL complications — PMC Postoperative fever after PCNL — systematic review and meta-analysis (PMC)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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