PCNL — Keyhole Stone Surgery

Keyhole surgery to remove large or complex kidney stones. Percutaneous nephrolithotomy (PCNL) is the gold-standard treatment for big or difficult stones that other methods cannot clear in one go. Through a single small track in the back, the whole stone is broken up and removed, giving a high chance of a stone-free kidney. Dr. Anish Gupta performs PCNL with modern equipment and careful technique in Delhi NCR.

What is PCNL?

PCNL stands for percutaneous nephrolithotomy — "percutaneous" meaning through the skin, and "nephrolithotomy" meaning removal of a kidney stone. The surgeon makes a small keyhole opening, usually less than a centimetre, in the back and passes a fine telescope directly into the kidney. Using laser or other energy, the stone is fragmented and the pieces are removed through the same track. Because even bulky stones can be cleared in a single procedure, PCNL is the preferred choice for large or complex stones.

Who needs PCNL?

PCNL is recommended when a stone is too large or complex for less invasive methods. It is typically used for:

• Large kidney stones (generally bigger than two centimetres)
• Staghorn stones that branch and fill much of the kidney
• Hard stones that resist shockwave therapy
• Stones that have not cleared with other treatments
• Stones associated with a blocked or poorly draining kidney

PCNL is one element of complete kidney stone care, and our kidney stone treatment guide explains how it compares with other options.

How the procedure works

PCNL is performed under general anaesthesia and usually takes one to a few hours depending on the stone. In simple terms:

1. You are anaesthetised so you are asleep and feel nothing throughout.
2. Using X-ray or ultrasound guidance, a fine needle and then a small track is made through the skin of the back into the kidney.
3. A telescope (nephroscope) is passed along the track to see the stone directly.
4. The stone is broken up with a laser or other energy source and the fragments are removed through the track.
5. A drainage tube and/or an internal stent may be placed for a short time to help the kidney heal, and any stone is sent for analysis.

Benefits

• Clears large and complex stones that other methods cannot manage alone
• High stone-free rate, often in a single procedure
• Only a small keyhole incision rather than open surgery
• Less pain and faster recovery than traditional open stone surgery
• Allows immediate removal of fragments rather than waiting for them to pass

Recovery and aftercare

Most people stay in hospital for a day or two after PCNL. Any drainage tube is usually removed before you go home, and an internal stent, if placed, is taken out later in a simple clinic visit. Some blood in the urine and mild discomfort around the wound are normal for a few days. Drinking plenty of fluids helps flush the kidney. Most people return to light activity within one to two weeks, avoiding heavy lifting for a little longer. Dr. Anish Gupta provides clear, written aftercare instructions.

Risks and safety

PCNL is a well-established and safe procedure in experienced hands. As with any surgery there are small risks, including bleeding, infection or fever, and — uncommonly — injury to nearby structures or the need for a further procedure to clear a residual fragment. These risks are minimised by careful technique, imaging guidance and good preparation. Dr. Anish Gupta will discuss them fully with you beforehand.

Why choose Dr. Anish Gupta

Dr. Anish Gupta is a Consultant Urologist & Andrologist with over 20 years of experience and advanced training in endo-urology and minimally-invasive stone surgery. He plans each PCNL carefully with modern imaging and laser technology to achieve the highest chance of a stone-free result. Where a stone is better suited to ureteroscopy or RIRS, he will recommend that instead. Care is available across three convenient locations in Delhi NCR (Ashok Vihar, Rohini and Karol Bagh).

Every treatment plan starts with a proper assessment, so you only get the care your condition actually needs — and if the honest answer is that you don't need a procedure, you'll hear that too.