With this technique, a large bore tract (30Fr) is dilated over a guide wire passed from the loin, traversing the renal parenchyma and entering into the pelvicalyceal system via a renal papilla. A nephroscope is then passed down the tract and calculi are fragmented and removed. This is then followed by a period of post-operative nephrostomy drainage (1-2 days) and typically the patient is in hospital for 3-4 days. The wound is approximately 1cm in diameter and normal activities are rapidly resumed, although full contact sport should be avoided for 4-6 weeks.
The indications for PCNL are large renal stone burdens (i.e. ›2cm, ›1.5cm for lower pole), ESWL or flexible ureterorenoscopic failures and in the treatment of concurrent intrarenal pathology (i.e. pelviureteric junction obstruction, calyceal diverticulum). Over the past few years, there has been a resurgence of interest in this technique as the indications for ESWL become more tightly defined. The technique continues to evolve with present research concentrating on the role of smaller tracts (the so-called Miniperc) and “tubeless” post-operative management.