Mini PCNL: Minimally Invasive Treatment for Large Kidney Stones

by Daniel Marchalik, MD, Director, Ambulatory Urologic Surgery
July 2, 2019

Each year, more than 500,000 people visit an emergency room because of a kidney stone. People with kidney stones often experience kidney or back pain, and the kidney pain can be so severe that some people even compare it to childbirth. Other symptoms of a kidney stone include:

  • Blood in the urine
  • Infection in the urine, which can cause urine to smell bad and look cloudy
  • Nausea or vomiting
  • Severe pain in the flank or groin

One of the most effective ways we treat kidney larger stones is through an outpatient tubeless mini percutaneous nephrolithotomy (mini PCNL). This minimally invasive surgery allows us to remove kidney stones through tiny incisions and provides patients with quick recovery times—especially compared to treatments we used years ago.

For example, we saw one patient with a large kidney stone that was blocking his kidney, causing considerable back pain and nausea. He was concerned because he thought it would require multiple surgeries to remove the kidney stone. However, we were able to perform a tubeless mini PCNL on him. He had surgery at 8:30 a.m. and was home by 1 p.m. with no pain or discomfort.

LISTEN: Dr. Marchalik discusses how doctors use mini PCNLs to treat kidney stones in the Medical Intel podcast.

How Does Outpatient Tubeless Mini PCNL Work, and Who’s a Candidate?

The word “percutaneous” means that surgeons are going through the skin into the kidney, and “nephrolithotomy” means that we’re taking the stone out of the kidney. PCNL begins with us making a small incision in the kidney. Then, through the back, we’ll reach the kidney, use a small scope and instrument to break the kidney stone up into smaller pieces, and suction the pieces out.

Following surgery, patients generally return home the same day without pain. Unlike traditional PCNL, with a tubeless PCNL, we send patient home without a tube in their back. Side effects are possible, however, as some people experience grogginess and nausea after anesthesia. Patients also can experience blood in the urine, as well as stomach and back discomfort for a few days.

The perfect candidates for mini PCNLs are people who have intermediate-sized kidney stones—usually slightly larger than a centimeter but less than a full staghorn calculi, which is a stone that occupies the whole kidney. However, individuals with larger kidney stones can still be candidates for tubeless same-day surgery. Meanwhile, people with very small kidney stones may be candidates for techniques such as extracorporeal shockwave lithotripsy, which is noninvasive and uses a machine to deliver shockwaves to the back to break up kidney stones. Make sure to speak to your doctor to determine which technique is best for you.

What separates mini PCNL from a standard PCNL is that it’s performed through a smaller opening and with smaller instruments. As a result, patients experience:

  • Less discomfort
  • Less pain
  • No drainage tube in the back
  • Quicker recoveries
Mini #PCNL is one of the best ways to remove #kidneystones. Compared to past techniques, it leads to less pain, less discomfort, and quicker recoveries. https://bit.ly/2Np6avB via @MedStarWHC @dmarchalik

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Are There Any Risks Involved with Mini PCNL?

When having a mini PCNL, there’s minor risk involved with anesthesia, like most any other surgery. Furthermore, because mini PCNL involves surgeons going through the back, there’s a small risk of damaging the organs that surround the kidney. There’s also a risk that not all the kidney stone is removed. When you have a considerably large stone, even when using this technique, some of it can be missed. That said, mini PCNL provides patients the greatest chance of completely removing kidney stones compared to other treatment options.

Expert Care at MedStar Washington Hospital Center

Our urology team performs a high volume of mini PCNLs at MedStar Washington Hospital Center. Additionally, our team-based approach to care allows us to review images of kidney stones with interventional radiology partners if it’s a complex case.

We also look at the whole patient when we remove kidney stones, not just the kidneys. After surgery, we follow patients for years, and we make dietary modifications and other changes that help ensure the patient doesn’t have kidney stones or other kidney conditions in the future.

We never want patients to have to suffer through the pain of kidney stones. Mini PCNL is the best treatment we have for select patients to not only eliminate the kidney stone but immediately relieve their pain.

Call 202-877-3627 or click below to make an appointment with a urologist.

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Category: Healthy Living, Medical Intel     Tags: kidney stonesmini pcnlpercutaneous nephrolithotomy