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Large Kidney Stone Removal

Also known as: percutaneous nephrolithotomy (PCNL) – a minimally invasive inpatient procedure performed under general anaesthesia to remove kidney stones, when they are too big and can’t pass on their own. “Percutaneous” means through the skin; the procedure involves creating a passageway from the skin on the back through to the kidney.

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Everything you need to know

You may need to have PCNL if you have the following:

  • Large Kidney stones – bigger than 2 cm
  • Lower pole kidney stones – bigger than 1.5cm
  • Staghorn Calculi
  • Complex intrarenal anatomy (caliceal diverticulum, horseshoe)
  • Associated distal obstruction (PUJ, ureter)
  • Reconstructed urinary tracts (ileoconduit)

…or if other treatments have not worked.

Before surgery

If you’re experiencing kidney stone pain or have been diagnosed with kidney stones, book an appointment with one of our consultant urologists.

At this appointment, your urologist will request a CT scan if you haven’t had one already, run some blood tests to check your kidney function, and a urine test to check for a urinary tract infection. If PCNL is recommended, they will explain what it involves, run through the risks and benefits of the procedure, and give you the opportunity to ask questions, so you can make an informed decision.

During surgery

PCNL is performed under general anaesthetic, meaning you will be asleep. It is a keyhole operation, which means a very small incision will be made in your skin. For a standard PCNL, the incision will be around 1cm and for a mini-PCNL, the incision will be 5mm. This is made in the skin of your flank to allow easy access to the kidneys. It can be performed with you lying on your front (prone position) or on your back (supine PCNL).

Once the surgeon gains access to the kidneys, the stone(s) will be disintegrated into very fine sand using state-of-the-art lasers such as Holmium laser, Thulium Fibre laser (TFL), broken down using ultrasound or ballistic devices.

Once all the stones have been removed, your urologist may leave a temporary drainage tube from your kidneys, such as a ureteric stent (internal) or nephrostomy (external drainage tube) as well as a urethral catheter to drain your bladder whilst you are waking up from the effects of anaesthesia. You will then be taken to our recovery ward.

After surgery

Once we’re happy you’re doing well, we will take you to your private room and our nursing team will make regular checks to make sure your recovery is going to plan. Most patients can go home 24 – 48 hours after their procedure. We will give you pain killers and antibiotics to take in the days following surgery.

You will need someone to collect you from hospital and look after you at home for a few days after surgery.

It’s important to keep the incision site clean and dry. If you notice any significant bruising, become feverish, or smell urine, call us urgently.

You should be able to resume your normal activities after 2 weeks.

How to pay for your treatment

If you’re… paying for yourself

Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.

For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.

If you’re… insured

St John & St Elizabeth Hospital is approved by all major medical insurance companies. If you have a personal private health insurance policy, or your company provide it for you, you can use it to pay for your care from your initial consultation through to treatment, surgery and aftercare such as physiotherapy. Not all private health insurance plans cover the same things. It’s very important to check exactly what you are covered for with your insurance provider.