When to do a percutaneous nephrolithotomy for kidney stone removal?
The convenience and safety of other procedures like extracorporeal shockwave lithotripsy (ESWL) makes it the preferred option for kidney stone destruction. At times, an ESWL may not be viable (refer to ESWL Contraindications) or is unsuccessful in fragmenting the stone, or the fragmented stone(s) may not pass out of the urinary system. In these instances, percutaneous nephrolithomy is indicated. With modern imaging techniques and pre-operative testing, the urologist can decide on which procedure would be more successful with minimal risk of complications. Other indications for a PCNL would include : • Kidney stones larger than 2cm (20mm stone). Sometimes an ESWL is still considered for large stones up to 3cm (30mm) which are soft, like calcium oxalate stones. • Hard stones like cystine kidney stones. • Stones causing an obstruction of the ureteropelvic junction (kidney-ureter). • Stone located towards the lower pole of the kidney. • Severe infection. In certain emergency cases where th
