How Percutaneous Nephrolithotomy Works?

Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgical procedure for removing upper ureteral stones and kidney stones larger than 2 centimeters in diameter. Historically, larger stones were removed in open surgery, which required a larger flank incision. Percutaneous nephrolithotomy (nephrolithotripsy) is a more refined alternative to open surgery, using a 1-centimeter skin incision. The procedure reduces blood loss, pain and hospital stay and has an increased success rate.

During PCNL, the patient is given general anesthesia before a needle is inserted through the skin to puncture the kidney and create a channel through which a nephroscope is passed into the kidney to break the stone into fragments for easy extraction. The entire procedure takes 3-4 hours.

During percutaneous nephrolithotomy:

  • The patient receives general anesthesia to make the procedure less painful. The patient then lies face down on the abdomen.
  • The surgeon performs cystoscopy (telescopic exam of the bladder) and instills X-ray dye or carbon dioxide into the kidney using a small catheter through the ureter of the affected kidney. This helps the surgeon to locate the stone more precisely.
  • After locating the stone, the urologist makes a small incision on the back and passes a tiny needle through the skin (under X-ray guidance) into the kidney to directly access the stone.
  • The needle tract is dilated to about 1-centimeter to enable placement of a plastic sheath and telescope for visualizing the stone.
  • Using a laser or mechanical lithotripsy device, the surgeon breaks the stone into smaller fragments and extracts the pieces through the sheath.
  • At the end of the operation, temporary catheters, a nephrostomy tube for the kidney and a stent tube for the bladder, are used to drain urine. The catheters are removed before discharge from hospital, usually after 2-4 days.

Percutaneous nephrolithotomy is recommended when:

  • Urine flow is blocked.
  • Kidney stones obstruct several branches of the collecting system of the kidney (also called staghorn kidney stones).
  • Kidney stones are bigger than 2 centimeters (0.8 inch) in diameter.
  • Urine leakage is occurring inside the body.
  • There is severe pain even after treatment for a kidney stone.
  • Kidney stone is causing damage to the kidney.
  • Other treatment options have failed.
  • The urologist will request several tests before the operation. Blood and urine tests check for infection and other problems, while a computerized tomography (CT) scan helps to determine the location of the stones.

Advantages of PCNL:

  • Minimally-invasive procedure, with less pain, quick recovery, shorter hospital stay (2-4 days) and quick return to work (7-10 days).
  • No surgical scar or complications associated with large incision operations.
  • Less risk of postoperative infections compared to open surgery.
  • Minimal harm to kidney function.
  • Limits residual stones, as the surgeon has the opportunity to look inside the renal calyx and ureter.
  • Percutaneous nephrolithotomy is effective for most people with stones in the ureter or kidney. Its stone free rate is greater than 90 percent and is the highest of all procedures.

For more information on treatment of kidney stones, visit Advanced Urology Institute.

What Causes Kidney Stones? Dr. Edward King Reveals the Science Behind Their Formation


  • Kidney stones are more likely to form in warm, humid climates and in individuals who do not consume enough fluids, leading to concentrated urine.
  • Consuming foods high in oxalate, such as green leafy vegetables, pecans, and nuts, increases the risk of kidney stone formation.
  • To prevent kidney stones, maintain proper hydration, limit high-oxalate food consumption, and consult with a urologist at the Advanced Urology Institute for personalized prevention and treatment plans.


Kidney stones are a common and painful condition that affects many people across the globe. Urologist in Ocala, FLDr. Edward D. King, provides insights into the science behind kidney stone formation, emphasizing the importance of understanding the factors that contribute to their development.

The Role of Climate and Hydration

According to Dr. Edward King, kidney stones tend to form more frequently in warm, humid climates. This is because the body loses more water through sweating, leading to more concentrated urine. When patients do not consume enough fluid to compensate for this loss, the risk of kidney stone formation increases.

Diet and Oxalate Consumption

Dr. King explains that diet also plays a crucial role in kidney stone formation, particularly the consumption of foods high in oxalate. Oxalate is a naturally occurring substance found in many foods, including green leafy vegetables (e.g., spinach and kale), as well as pecans and nuts. Consuming high levels of oxalate increases the likelihood of forming kidney stones, as this substance is not very soluble in water or urine.

The Formation and Migration of Kidney Stones

When kidney stones form, they begin as small crystals that grow slowly over time. The pain associated with kidney stones typically occurs when the stone migrates into the ureter, the tube that carries urine from the kidney to the bladder. This migration blocks the flow of urine, causing the kidney to swell and resulting in intense pain in the back, flank, and groin areas.

Prevention and Treatment

To prevent kidney stones, Dr. King recommends maintaining proper hydration and limiting the consumption of high-oxalate foods. Additionally, working with a healthcare professional, such as a urologist at the Advanced Urology Institute, can help patients develop personalized prevention and treatment plans.

The Advanced Urology Institute is the largest urology practice in Florida, offering comprehensive care for various urological conditions, including kidney stones. With a team of experienced professionals and state-of-the-art facilities, patients can expect exceptional care and support throughout their treatment journey.


Well, kidney stones often form in warm, humid climates. They occur in concentrated urine when patients don’t consume enough fluid.
It can also be diet related. There’s a substance called oxalate that’s found naturally in many foods such as green leafy vegetables, spinach, kale, pecans, and nuts.

So patients who consume foods that are high in oxalate are much more likely to form kidney stones because the substance oxalate is not very soluble in water or urine. Stones typically cause pain by blocking the flow of urine. When the stone is forming in your kidney, it starts as a small crystal and just grows slowly often.

When it migrates into the tube that carries urine from the kidney to the bladder called the ureter, then it blocks the flow of urine. The kidney swells and that’s when patients get pain. There’s actually pain in the back or in the flank that radiates to the front and often down into the groin. It can be pretty intense pain.