Percutaneous nephrolithotomy (PCNL) is a surgical procedure to remove stones

Kidney stone

A kidney stone, also known as a renal calculus is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine...

 from the kidney

Kidney

The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...

 by a small puncture wound (up to about 1 cm) through the skin

Skin

-Dermis:The dermis is the layer of skin beneath the epidermis that consists of connective tissue and cushions the body from stress and strain. The dermis is tightly connected to the epidermis by a basement membrane. It also harbors many Mechanoreceptors that provide the sense of touch and heat...

. It is most suitable to remove stones of more than 2 cm in size. It is usually done under general anesthesia

Anesthesia

Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

 or spinal anesthesia.

Procedure

A Retrograde pyelogram

Retrograde pyelogram

Retrograde Pyelogram is a urologic procedure where the physician injects contrast into the ureter in order to visualize the ureter and kidney. The flow of contrast is opposite the usual flow of urine, hence the retrograde name.Reasons for performing a retrograde pyelogram include identification of...

 is done to locate the stone in the kidney

Kidney

The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...

. With a small 1 centimeter incision in the loin

Loin

The loins are the sides between the lower ribs and pelvis, and the lower part of the back. It is often used when describing the anatomy of humans and quadrupeds . The anatomical reference also carries over into the description of cuts of meat from some such animals, eg...

, the Percutaneous nephrolithotomy (PCN) needle is passed into the pelvis of the kidney. The position of the needle is confirmed by fluoroscopy

Fluoroscopy

Fluoroscopy is an imaging technique commonly used by physicians to obtain real-time moving images of the internal structures of a patient through the use of a fluoroscope. In its simplest form, a fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed...

. A guide wire is passed through the needle into the pelvis. The needle is then withdrawn with the guide wire still inside the pelvis. Over the guide wire the dilators are passed and a working sheath is introduced.
A nephroscope is then passed inside and small stones taken out. In case the stone is big it may first have to be crushed using ultrasound probes and then the stone fragments removed.

Complications

The following complications may take place:

• Injury to the colon
• Injury to the renal blood vessels
• Urinary leak may persist for few days
• Sepsis
  Sepsis
  Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
  
  
• Hydrothorax if PCNL is done through 11th intercostal space