What Is Percutaneous Nephrolithotomy?

Percutaneous nephrolithotomy is suitable for: kidney stones above 2cm, kidney stones below 2cm that are ineffective or accompanied by obvious hydronephrosis, and some upper ureter stones.

Wang Gang	(Deputy Chief Physician)	Department of Urology, Peking University First Hospital
Zhang Xiaochun	(Deputy Chief Physician)	Department of Urology, Peking University First Hospital

Percutaneous nephrolithotomy is to establish a channel from the skin to the kidney at the waist, insert the nephroscope into the kidney through this channel, and use the lithotripsy tools such as laser and ultrasound to crush and remove the kidney stones. It's called "Punching Stones." The English abbreviation is PCNL. Percutaneous nephrolithotomy is a modern minimally invasive technique for the treatment of kidney stones. Peking University First Hospital was the first to carry out this technique in China in 1985. Now hundreds of operations are performed every year, and open surgery for stone removal has basically been eliminated.

Chinese name

Percutaneous nephrolithotomy

Foreign name

PCNL

Indications for percutaneous nephrolithotomy

Percutaneous nephrolithotomy is suitable for: kidney stones above 2cm, kidney stones below 2cm that are ineffective or accompanied by obvious hydronephrosis, and some upper ureter stones.

Advantages of percutaneous nephrolithotomy

Methods for surgical treatment of kidney stones include: incision lithotripsy, extracorporeal lithotripsy, percutaneous nephrolithotomy, and soft ureter lithotripsy.

The traditional method of "surgery and stone removal" requires a large incision of about 20 cm in the waist, cuts the muscles in the waist, separates the kidneys, and cuts a small opening in the renal pelvis or kidney parenchyma to remove the stones. This method has large damage, more bleeding, severe pain, and slow recovery. Hospitalization usually takes about 7 days after surgery. Because the surgical incision is large, not only the skin is not beautiful, but also the physical strength of the patient is greatly affected after the operation.

Compared with open surgery, percutaneous nephrolithotomy has the advantages of less damage, less pain, thorough stone removal, and faster recovery. The incision in the waist is usually less than 1cm. Because it does not cut the muscles, it not only does not affect the aesthetics, but also has little effect on the labor force after the operation. They are usually discharged 2 to 3 days after the operation.

Compared with laparoscopic stone removal, percutaneous nephrolithotomy has less effect on the kidney and surrounding structures, and does not affect various kidney operations in the future. Compared with extracorporeal lithotripsy, it has a short treatment cycle, immediate results, and less impact on renal function.

Technical characteristics of percutaneous nephrolithotomy

Percutaneous nephrolithotomy is a very technical operation. We know that the kidney is an organ with abundant blood vessels, and the blood flow of the kidney accounts for 1/4 of the blood discharged from the heart. It is necessary to avoid bleeding, try to remove stones, and protect kidney function, which requires very sophisticated surgical techniques. To some extent, this operation is much more difficult than nephrectomy for kidney cancer.

This surgery requires individualized treatment, which is to determine different channel positions, channel sizes, and corresponding lithotripsy tools according to the specific conditions of the patient's stone site, number, size, and composition. Improper access can increase the risk of bleeding, complications, and residual stones. This requires very standard diagnostic procedures and sophisticated operating techniques. ^[1-4]