Percutaneous Nephrolithotomy

Dr. Rashid Al-Yousef Updated: 20 April، 2025 6 min read

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Percutaneous nephrolithotomy in Turkey/Istanbul is considered the ideal method for fragmenting and extracting large kidney stones, especially those located in the pelvis or ureter.

Description of percutaneous nephrolithotomy

Percutaneous nephrolithotomy (PNL) is a simple procedure used for large stones inside the kidney, but it is not used for stones inside the ureter or bladder.

It is used if there is a large stone (usually more than 1-2 cm in size), and it cannot be broken up with a shock wave device from outside the body or through ureteroscopy.

Although this procedure is more invasive than shock waves, it is more effective for large stones, especially if they are hard.

It is the treatment of choice for deer antler stone, a large stone that almost fills the kidney. Percutaneous nephrolithotomy (PNL) requires general anesthesia.

This procedure requires an integrated medical team, including a urologist, a radiologist, and a full surgical team (such as a physician, anesthesia technician, nursing assistant, surgical assistant, and radiology technician).

The patient will also be required to stay in the hospital for some time after treatment.

Before performing percutaneous nephrolithotomy

CT scan to determine the location and location of the stone
Anesthesia consultation required
Blood tests and ECG
Fasting the night before
Medications: You will receive instructions about any changes. In general, you will be asked to stop all medications predisposing you to bleeding (such as Plavix, Coumadin/warfarin, and aspirin).

Percutaneous nephrolithotomy surgery in Turkey

Percutaneous nephrolithotomy is performed under general anesthesia.

The patient lies on his stomach, face down. Once anesthesia is given, your doctor will perform a cystoscopy (a telescopic examination of your bladder) and inject X-ray dye into the kidney through a small catheter placed through the ureter to clearly “map” the kidney.

This allows the surgeon to precisely locate the stone within the kidney and place a small needle through the skin under X-ray guidance to directly reach the area where the stone is located.

The stones are broken down into small pieces and extracted from the body using an ultrasonic, mechanical, or laser fragmentation device.

Sometimes, more than one device may be needed to access all stones and attempt to remove them.

A small ureteral catheter may be left in place to drain stones from the kidney into the bladder and a tube that acts as a drain through the kidney to an external drainage bag at the end of the procedure.

The duration of surgery generally takes 3-4 hours.

Verifying the success of percutaneous nephrolithotomy

The next day after the surgical procedure, the doctor performs tests to ensure the success of the operation before leaving the hospital.

Fortunately, the majority of patients will be able to leave the hospital without stones.

Sometimes, stones cannot be extracted, and additional procedures such as shock wave lithotripsy (ESWL), ureteroscopy, or even repeated percutaneous nephrolithotomy are required.

In some cases, a catheter may be left within the ureter to allow fragments to pass and/or allow the kidney to heal properly.

You will be informed if additional procedures are needed later, such as removing the catheter, ureteroscopy, or morcellation sessions.

Ureteroscopy Using A Flexible Endoscope To Rule Out Pathological Problems In The Ureter

Potential risks

One of the great benefits of percutaneous nephrolithotomy is that it helps the patient get rid of the stones with a less invasive procedure than the procedures used in the past.

Fortunately, the patient is rarely treated with open surgery now because it requires a large incision in the body, and the need to stay a few days in the hospital and several weeks of rest are recommended for recovery.

While percutaneous nephrolithotomy is much better than open surgery, it does carry some risks.

The incidence of potential risks is about 5-10%, While the incidence of more serious complications is small, about 1-2% of cases.

These include the following:

Bleeding: about 5% requiring a blood transfusion: occurs commonly during the procedure but may occur late during the first month after surgery

. If severe and severe bleeding occurs or the amount of pre-existing bleeding increases, tell your doctor and go to a nearby hospital. Sometimes, part of the kidney must be embolized to stop the bleeding.

Damage to nearby organs (such as the spleen, colon, liver, and lung) can occur, which is rare and uncommon.

If you have questions that have not been answered here, please contact us.

What to expect from percutaneous nephrolithotomy in Turkey ?

It is normal for some blood in the urine and bruising to appear on the lower flank after the procedure. The problem usually resolves within days to a few weeks on its own.

As long as the blood in the urine is light, there is generally nothing to worry about.

Urinary tract infections can sometimes occur, depending on the type of stone removed. Antibiotics are given after stone extraction to prevent infection, but if you have a fever, please ask your urologist.

Sometimes a small tube is temporarily inserted into the skin to drain pus and fluid from the kidney. This will be removed as soon as it is safe to do so.

When should you see a doctor after percutaneous nephrolithotomy?

Please inform your doctor if you have any of the following:

Severe bleeding in the urine
Feeling faint or dizzy despite consuming sufficient amounts of food and fluids
High body temperature
Very painful symptoms appear

Bimaristan Medical Center remains your first choice for treatment in Turkey.

We direct you to the best expert specialists in all fields. We break the language barrier. Arab specialist doctors will help you communicate with your doctor. We help you book an appointment in Turkey’s most important and modern hospitals.

We provide our services throughout Turkey, so the best place to provide you with treatment is our destination.

We accompany you step by step towards recovery.

Free consultations around the clock.

Do not hesitate to contact us at Bimaristan Family Center in Turkey. Our website also provides information about bladder cancer and its treatments in Turkey.

To learn more about the kidney transplantation process in Turkey and to learn more about percutaneous removal of kidney stones, you can contact us

Sources:

Johns Hopkins Medicine

Frequently Asked Questions

What is the advantage of percutaneous nephrolithotomy compared to other stone treatments?

The main advantage of percutaneous nephrolithotomy over other treatments, such as shock wave lithotripsy or transureteroscopy, is that it provides a minimally invasive method of treating and removing kidney stones with a single procedure compared to the need for multiple surgeries with the other treatments mentioned.

Are there disadvantages to percutaneous nephrolithotomy?

While ureteroscopy can be performed with local anesthesia, percutaneous nephrolithotomy requires general anesthesia.

Some patients may be unable to tolerate general anesthesia due to their medical condition.

Compared to other treatments, percutaneous kidney stone extraction is considered more invasive and carries slightly higher risks.

However, for most patients with large or multiple stones or resistance to other forms of treatment, the benefits of percutaneous kidney stone extraction outweigh the risks.

Who are the suitable patients for percutaneous nephrolithotomy?

Patients who suffer from severe heart or lung diseases or have clotting disorders and a bleeding tendency are not suitable for percutaneous renal lithotomy.

Patients with active urinary tract infections are more likely to develop sepsis during surgery. Therefore, they should be treated with antibiotics to clear the infection before the kidney stones are extracted from the body.

Can multiple stones be treated at the same time in this way in Turkey?

Yes, it is possible. This is one of the advantages of this method, as a flexible scope can be passed through the skin directly into the kidney to try to identify the location of the stones and remove them together.

However, despite the use of a flexible endoscope, it may sometimes be difficult to image all areas of the kidney, and therefore, some stones may not be able to be removed.

This may require a second percutaneous nephrolithotomy at a later date.

Alternatively, percutaneous nephrolithotomy may remove a large section of the stone by ureteroscopy and leave shock wave lithotripsy to clean the remaining fragments.

Will I need to have an internal ureteral stent placed after percutaneous nephrolithotomy?

In most cases, a ureteral stent is placed to facilitate urine drainage from the kidney to the bladder.

What is the overall success rate of percutaneous nephrolithotomy in Turkey?

The success of percutaneous nephrolithotomy depends on many factors, such as the structure of the stones, their size, their number in the kidney, their location within the urinary tract, and the patient’s body structure (obesity).

Our surgeons carefully consider all of the above variables and will discuss them with you in order to achieve maximum success and determine if percutaneous kidney stone removal is right for you.

The overall success rate is about 80-90% after the initial percutaneous nephrolithotomy procedure and 90-100% after the “second look” procedure.

How do I know if percutaneous nephrolithotomy was successful?

After percutaneous nephrolithotomy, your surgeon will determine whether treatment was successful based on a CT scan performed during your hospitalization on the first day after surgery.

If stone fragments remain within the urinary tract, it may take more time for them to pass spontaneously, which often takes several weeks.

Alternatively, the surgeon may recommend repeating the procedure, shock wave lithotripsy, or ureteroscopy.

Can percutaneous nephrolithotomy be repeated in Turkey?

Yes. Often, due to the density of the kidney stone, its size, or its precise location in the urinary system, fragments may sometimes remain in the urinary tract, requiring a “second look” procedure to attempt removal.

This is usually performed a few days after the initial surgery.

Alternatively, this second procedure may be performed later based on the doctor’s opinion.

Can percutaneous nephrolithotomy be performed on both kidneys at the same time in Turkey?

If patients have significant stone burdens in both kidneys, percutaneous nephrolithotomy surgeries may be performed on both kidneys at the same site or at a later time as two separate surgeries.