Percutaneous nephrolithotomy (PCNL)

Kidney stones are relatively uncommon in children compared to adults. The meat of the kidney produces pee (urine) which then passes into a funnel-shaped drainage sac called the pelvis. From here, the pee flows downward to the bladder along a tube called the ureter. Pee is stored in the bladder and then passed out through a tube called the urethra which is short in girls but longer in boys as it passes through the penis.

Where can stones form?

Most stones appear in the kidney with the rest happening in the ureter (the pee tube from kidney to the bladder) or the bladder.

How can stones be removed?

Urinary tract stones can be treated by an operation. These can be open surgery or keyhole surgery.

The choice depends on:

• the child’s age
• the position of the stone
• the size of the stone
• the anatomy of the urinary tract
• any other associated problems your child may have

Your child is going to have percutaneous nephrolithotomy for their kidney stone.

What is percutaneous nephrolithotomy (PCNL)?

This is a special technique where tubes are put directly into the kidney letting us break up the stone and remove it.

What will happen before the PCNL?

Before the operation, your child will need blood and urine tests which can be done from the clinic. This can be done on the day of surgery or at your local hospital.

On the day before or the day of surgery, your child will need an X-ray or ultrasound of their tummy. This is to make sure where the stones are and how many there are.

You will be told about your child not being able to eat or drink before the operation.

Your child may be admitted on the day of or the day before their surgery.

What exactly does PCNL involve?

The operation is done under a general anaesthetic. We will make a hole in the kidney from the back with a needle to cut out the stone and remove it.

Needle going into kidney to puncture kidney stone

Hollow tube going in near to kidney stone

Kidney stone has been broken into smaller pieces

After the operation, we will fit a catheter so your child can pee.

The whole procedure usually takes 2 to 4 hours.

What will the post-operative recovery be like?

After the operation, your child will be on an intravenous (IV) drip. They will be able to start drinking and eating within 24 hours of the surgery and then the drip will be removed. They will also be on a special drip for pain relief.

Your child will have antibiotics through the drip to begin with and then by tablets.

The drain will be turned off after 24 to 36 hours. It is removed if your child is feeling well. Sometimes the drain may need to be left in longer if more procedures are needed. Your child will be able to go home around 2 days after surgery.

What are the possible complications of PCNL?

There are some complications but most cases are straightforward:

• Blood in the urine is normal and settles without treatment.
• Serious bleeding may need a blood transfusion or an open operation.
• Failure to put a hole in the kidney will stop the operation. In this case, we will try again in 6 to 8 weeks if needed.
• Retroperitoneal haematoma is a large blood clot around the kidney.
• Infection is reduced with antibiotics.
• Fever can be managed paracetamol, ibruprofen (if the kidneys work okay), and may need antibiotics.
• Collection of pee around the kidney. This is called a urinoma and normally settles or can be drained.
• Movement or loss of pee tube.
• Break or injury to the drainage system of the kidney (renal pelvis or ureter) or damage to the kidney. Damage to the drainage system can be fixed by leaving the drain in longer.
• Leftover or another stone.
• Imbalance of salts in the body.
• Reactions from the dye used to show the kidney during the operation.

What happens after leaving the hospital?

After leaving the hospital, children make a quick recovery and may do normal activities within 2 weeks. Children may have a bath or shower anytime after leaving the hospital.

Your child will need to stay on antibiotics for up to a year following their surgery. 

Are any further appointments necessary after the operation?

Your child may be followed up in Sheffield or at your local hospital, based on where you live and what you need. This may include an X-ray or an ultrasound. More tests may be needed if anything is found in these tests.