PCNL Kidney Stone Surgery Melbourne
Percutaneous Nephrolithotomy (PCNL) is a keyhole surgical technique for removing large or complex kidney stones. The procedure involves creating a small tract (approximately 1cm) through the skin and into the kidney, allowing direct access to break up and remove stones. PCNL is the gold-standard treatment for large kidney stones (>20mm), staghorn calculi, and stones that have failed other treatments.
Written and clinically reviewed by Dr Brendan Dias
Consultant Urologist & Robotic Surgeon · MBBS, MS (General Surgery), DrNB (Urology), IntFRCS (England), FUSANZ, FRACS (Urology)
Last clinically reviewed: 26 August 2026
Benefits
- Highest stone-free rates for large stones (>90%)
- Single procedure for complete stone removal
- Ability to treat any stone composition including very hard stones
- Direct visualisation and complete stone extraction
- Superior to ESWL and ureteroscopy for large stone burden
- Can treat staghorn calculi filling the entire kidney collecting system
The Procedure
The procedure is performed under general anaesthesia and typically takes 1-3 hours. A ureteric catheter is placed via cystoscopy. Ultrasound and/or X-ray is used to identify the optimal entry point. A needle is inserted through the skin into the kidney. The tract is dilated to create access (typically 1cm). A nephroscope is inserted into the kidney. Stones are fragmented using ultrasonic, laser, or pneumatic energy. Stone fragments are removed directly and a nephrostomy tube is placed temporarily.
Who Is a Candidate?
PCNL is recommended for large kidney stones greater than 20mm, staghorn calculi filling the kidney, multiple kidney stones requiring clearance, failed ESWL or ureteroscopy for smaller stones, very hard stones (cystine, calcium oxalate monohydrate), and lower pole stones with unfavourable drainage anatomy.
Recovery
Typical hospital stay is 2-3 days. Nephrostomy tube is kept in place for 1-2 days then removed. Avoid heavy lifting for 2-4 weeks. Light activities resume within 1 week. Most patients return to work within 1-2 weeks. Avoid contact sports for 4 weeks.
Risks & Considerations
Common effects include blood in urine and temporary pain at access site. Occasional complications (5-15%) include bleeding requiring transfusion, residual fragments, fever or infection, and prolonged urine leak. Rare complications include injury to surrounding organs, significant bleeding requiring intervention, loss of kidney function, or sepsis.