Percutaneous Nephrolithotomy (PCNL): Procedure, Risks, and Recovery
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgery that removes large or complex kidney stones through a small incision in the back. It is usually recommended when a stone is 2 centimeters or bigger, or when other treatments have failed or are not possible. The operation takes two to four hours, most people stay in the hospital for one day, and recovery takes two to four weeks. It is highly successful, but it is still a major surgery with risks such as infection, bleeding, and kidney damage [1].
Quick Answer
Percutaneous nephrolithotomy (PCNL) is a surgery for kidney stones too large to pass on their own. A urologist makes a small incision in the back and uses a nephroscope to remove the stone. It is the usual choice for stones of 2 centimeters or more, succeeds in about 75% to 98% of cases and heals faster than open surgery. [1]
What the research says
For stones over 20 mm, PCNL cleared more stones in children. A meta-analysis of 4 studies (231 PCNL and 212 retrograde intrarenal surgery cases) in pediatric patients found a higher stone-free rate with PCNL for stones larger than 20 mm (OR 6.38, 95% CI 1.83-22.22) but no significant difference for smaller stones; PCNL meant a longer hospital stay, and the quality of evidence was low (Lu et al., Medicine, 2017).
Leaving out the nephrostomy tube shortened surgery and hospital stay. A meta-analysis of 26 studies comparing tubeless with standard PCNL found shorter operative time (mean difference -5.18 minutes) and hospital stay (-1.10 days), and fewer urinary fistulas (RR 0.18, 95% CI 0.07-0.47), with no difference in transfusion, sepsis, or stone-free rate (Gauhar et al., Urolithiasis, 2022).
Tranexamic acid in the irrigation fluid may cut bleeding. A 2026 review of 28 studies described PCNL as the gold-standard treatment for large renal and upper ureteral stones and found that tranexamic acid reduced blood loss, transfusion rates, and hospital stay, while antibiotic or povidone-iodine irrigation showed promise for reducing postoperative fever and sepsis (Xiao et al., Urolithiasis, 2026).
Research summaries are based on article abstracts retrieved from PubMed.
What Is Percutaneous Nephrolithotomy?
"Percutaneous" means the procedure is done through the skin, and "nephrolithotomy" means removing a stone (calculus) from the kidney. PCNL is minimally invasive, so it has fewer complications, less impact on the body, and faster healing than open surgery. It is still a major surgery and is more invasive than other kidney stone treatments [1].
Providers usually suggest PCNL when other treatments, such as laser ureteroscopy or extracorporeal shock wave lithotripsy, do not work or are not possible. The best candidate has a stone that is 2 centimeters or bigger, or one with an irregular shape that makes it hard or impossible to pass through the urinary system [1].
How is percutaneous nephrolithotomy (PCNL) done, and how do you prepare?
Percutaneous nephrolithotomy preparation includes a health check, medication review and imaging, and the operation is done under general anesthesia and usually takes two to four hours.
Preparing for surgery
Before surgery your provider checks your general health and vital signs, reviews your medications (especially those that raise the risk of bleeding), and asks about allergies. Imaging such as a CT scan, ultrasound, or X-ray may be used to see the kidneys and the stone. You should not eat or drink anything after midnight the night before, and any necessary medications should be taken with a small sip of water [1].
During the procedure
A team that includes a urologist, an anesthesiologist, nurses, and surgical technicians performs the operation under general anesthesia. Most people lie on their stomach (prone), though some are positioned on their back (supine) or on their back with a cushion under the flank. The operation usually takes two to four hours [1].
Procedure Step | Description |
Incision | A small opening of about 1 cm (half an inch) is made in the back. |
Access | A protective sleeve is passed through the incision into the kidney. |
Removal | A nephroscope (small video camera) is used to find and remove the stone. |
Fragmentation | A laser or shock-wave device (lithotripter) may break the stone into smaller pieces first. |
Drainage | A drainage tube or ureteral stent may be placed to drain urine and promote healing. |
After the procedure
You are moved to a recovery room where your health is monitored and your pain is treated. The stone is often sent to a lab, because knowing what it is made of can help identify its cause and prevent new stones. Most people stay in the hospital for one day, and small amounts of blood in the urine for a week or two are normal [1].
What are the benefits, risks and success rates of PCNL?
The main benefit of PCNL is removing stones that are too big to pass or that do not respond to other treatments, with a faster recovery than open surgery. The success rate is about 75% to 98% [1].
All surgeries carry risks, even minimally invasive ones. Possible complications include [1]:
Anesthesia risks and healing problems.
Infection, including sepsis or a complicated urinary tract infection.
A mass of clotted blood (hematoma) and blood clots.
Fluid buildup at the surgical site (seroma).
Kidney damage.
Being unable to remove the whole stone, or needing additional procedures.
For most people the procedure is moderately painful. If you have a drainage tube, pain should improve once it is removed, and sometimes the ureteral stent is the most painful part [1].
What is recovery and long-term outlook after PCNL?
Most people recover in two to four weeks. Avoid strenuous activity, and do not lift anything heavier than a gallon of water (about 8.5 pounds) for at least two weeks. Most people can return to work or school after about a week, while physically demanding jobs may need at least two weeks off [1].
When to Call Your Provider
Schedule a checkup four to six weeks after PCNL, and call your provider right away if you have [1]:
Heavy bleeding or discolored drainage at the incision site.
Blood clots that look like ketchup, or dark blood in your urine.
A fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher.
Signs of infection, including chills, headache, or a bad odor around the surgical site.
Skin separation at your stitches, or increased pain.
Conclusion
PCNL is an effective and relatively safe way to remove large or complex kidney stones. Its small incision gives a shorter recovery than open surgery, but it is still a major operation. If you have persistent or large kidney stones, ask your healthcare provider whether PCNL is the right option for you [1].
Frequently Asked Questions
How long does a PCNL surgery take?
Usually two to four hours, depending on the size and complexity of the stone [1].
Is percutaneous nephrolithotomy a major surgery?
Yes. It is minimally invasive because it uses a small incision, but it is still a major surgery performed under general anesthesia [1].
How long is the hospital stay after PCNL?
Most people stay in the hospital for one day so providers can make sure healing is on track and pain is controlled [1].
What is the success rate of PCNL?
About 75% to 98% [1].
Are there lifting restrictions after PCNL?
Yes. Do not lift anything heavier than a gallon of water (about 8.5 pounds) for at least two weeks [1].
Is blood in the urine normal after PCNL?
Small amounts of blood in the urine for a week or two are normal. Call your provider if you see blood clots that look like ketchup or dark blood [1].
When can I return to work after PCNL?
Most people can return to work or school after about a week. If your job is physically demanding, plan on at least two weeks off [1].
What happens to the stone after it is removed?
The stone is often sent to a lab to find out what it is made of, which can help determine its cause and prevent new stones [1].
What are the main risks of PCNL?
Infection or sepsis, bleeding and blood clots, hematoma, seroma, kidney damage, healing problems, anesthesia risks, and the possibility that the stone cannot be fully removed [1].
When should I call my provider after PCNL?
Right away for heavy bleeding, ketchup-like clots, dark blood in the urine, a fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher, signs of infection, or increased pain [1].
Related Resources
External resource for deeper reading:
Cleveland Clinic. Percutaneous Nephrolithotomy. Cleveland Clinic Health Library. Last updated March 3, 2026. https://my.clevelandclinic.org/health/treatments/17349-percutaneous-nephrolithotomy
Related Reading
Nephroscopy: Kidney Scope Procedure for Stones, Recovery and Risks explains the kidney scope used to remove large stones.
References
Cleveland Clinic. Percutaneous Nephrolithotomy. Cleveland Clinic Health Library. Last updated March 3, 2026. https://my.clevelandclinic.org/health/treatments/17349-percutaneous-nephrolithotomy
Lu P, Song R, Yu Y, et al. Clinical efficacy of percutaneous nephrolithotomy versus retrograde intrarenal surgery for pediatric kidney urolithiasis: a PRISMA-compliant article. Medicine (Baltimore). 2017;96(43):e8346. PMID: 29069011. doi:10.1097/MD.0000000000008346
Gauhar V, Traxer O, García Rojo E, et al. Complications and outcomes of tubeless versus nephrostomy tube in percutaneous nephrolithotomy: a systematic review and meta-analysis of randomized clinical trials. Urolithiasis. 2022;50(5):511-522. PMID: 35674819. doi:10.1007/s00240-022-01337-y
Xiao L, Guo M, Xie J, Deng J, You Y. Progress in the study of irrigation strategies for percutaneous nephrolithotomy: a narrative review of the current literature. Urolithiasis. 2026;54(1):31. PMID: 41533145. doi:10.1007/s00240-025-01932-9
Medical disclaimer
This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have about a medical condition.
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