Skip to main content

Percutaneous Nephrolithotomy (PNL)

  • Chapter
  • First Online:
  • 1156 Accesses

Abstract

Percutaneous nephrolithotomy (PNL) is a gold standard for the management of stones in the kidney. PNL offers good clearance rates with minimal morbidity. The key to success in a PNL includes proper patient selection and technique. The factors to be considered while selecting the patient for PNL include the stone size, location, and the pelvicalyceal anatomy. In this chapter, we discuss the indications and the technique of PNL. PNL offers good clearance rates with minimal morbidity with proper patient selection and technique. The current indications for PNL include stone size larger than 2 cm, staghorn calculi and multiple complex calculi, lower polar stones larger than 1 cm, stones in calyceal diverticula, and stones in horseshoe kidney, malrotated, pelvic kidneys. A perfect percutaneous renal access is “key” to success. The choice of access may be fluoroscopic or ultrasound-guided. PNL in patients with chronic kidney disease requires strategic preoperative, intraoperative, and postoperative planning.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   159.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  • Al Kandari AM, Jabbour M, Anderson A et al (2007) Comparative study of degree of renal trauma between amplatz sequential fascial dilatation and balloon dilatation during percutaneous renal surgery in a animal model. Urology 69:586–589

    Article  Google Scholar 

  • Auge BK, Lallas CD, Pietrow PK et al (2002) In vitro comparison of standard ultrasound and pneumatic lithotrites with a new combination intracorporeal lithotripsy device. Urology 60(1):28–32

    Article  PubMed  Google Scholar 

  • De la Rosette J, Assimos D, Desai M, CROES PCNL Study Group et al (2011) The clinical research office of the endourological society percutaneous nephrolithotomy global study: indications, complications, and outcomes in 5,803 patients. J Endourol 25(1):11–17

    Article  PubMed  Google Scholar 

  • Denstedt J, Khoury S (eds) (2008) Stone disease. In: 2nd international consultation on stone disease, edn 2008. Health Publications, Paris, pp 157–164

    Google Scholar 

  • Denstedt JD, Clayman RV, Picus DD (1991) Comparison of endoscopic and radiological residual fragment rate following percutaneous nephrolithotripsy. J Urol 145(4):703–705

    PubMed  CAS  Google Scholar 

  • Desai M, Kukreja R, Desai M et al (2004) A prospective randomised comparison of type of nephrostomy drainage following percutaneous nephrostomy: large bore versus small bore versus tubeless. J Urol 172:565–567

    Article  PubMed  Google Scholar 

  • Fernstorm I, Johansson B (1976) Percutaneous pyelolithotomy: a new extraction technique. Scand J Urol Nephrol 10:257–259

    Google Scholar 

  • Frattini A, Barbieri A, Salsi P et al (2001) One shot: a novel method to dilate the nephrostomy access for percutaneous lithotripsy. J Endourol 15:919–923

    Article  PubMed  CAS  Google Scholar 

  • Halebian GE, Sur RL, Albala DM et al (2007) Subcutaneous bupivacaine infiltration and postoperative pain perception after PCNL. J Urol 178:925–928

    Article  Google Scholar 

  • Kukreja R, Desai M, Patel S et al (2004) Factors affecting blood loss during percutaneous nephrolithotomy. A prospective study. J Endourol 18(8):715–722

    PubMed  Google Scholar 

  • Paul EM, Marcowich R, Lee B et al (2003) Choosing the ideal nephrostomy tube. BJU Int 92:672–677

    Article  PubMed  CAS  Google Scholar 

  • Pearle MS, Watamull LM, Mullican MA (1999) Sensitivity of noncontrast helical computerized tomography and plain film radiography compared to flexible nephroscopy for detecting residual fragments after percutaneous nephrostolithotomy. J Urol 162(1):23–26

    Article  PubMed  CAS  Google Scholar 

  • Pietrow P, Auge B, Lallas C et al (2003) Pain after percutaneous nephrolithotomy: impact of nephrostomy tube size. J Endourol 17:411–414

    Article  PubMed  Google Scholar 

  • Shah VR, Modi MP, Chauhan NC et al (2011) The analgesic efficacy of peritubal infiltration of 0.25% bupivacaine in percutaneous nephrolithotomy – a prospective randomized study. J Anaesthesiol Clin Pharmacol 27(4):481–484

    Article  PubMed  Google Scholar 

  • Ugras M, Ilksen H, Gunen H et al (2007) Instillation of skin, nephrostomy tract, and renal puncture site with ropivacaine decreases pain and improves ventilatory function after percutaneous nephrolithotomy. J Endourol 21:499–503

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mahesh R. Desai .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Ganpule, A.P., Desai, M.R. (2013). Percutaneous Nephrolithotomy (PNL). In: Knoll, T., Pearle, M. (eds) Clinical Management of Urolithiasis. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28732-9_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-28732-9_11

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-28731-2

  • Online ISBN: 978-3-642-28732-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics