Rigi10™ Malleable Penile Prosthesis
Also Known As
PCNL, Percutaneous Nephrolithotripsy, Percutaneous Renal Stone Removal, Percutaneous Stone Extraction, Percutaneous Kidney Stone Surgery
Definition
Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove kidney stones from the body when they cannot pass on their own.1 The term “percutaneous” means through the skin. The procedure creates a passageway from the skin on the back to the kidney, where a surgeon uses specialized instruments passed through a small tube to locate and remove stones from the kidney.1 PCNL is primarily indicated for larger stones (>2 cm), staghorn calculi (stones that occupy multiple branches of the collecting system), or when less-invasive procedures such as shock wave lithotripsy or ureteroscopy are not possible or have failed.1,2 This technique has largely replaced open stone surgery for most complex kidney stones, offering a higher success rate for complete stone clearance while minimizing surgical trauma.3
Clinical Context
Percutaneous nephrolithotomy is clinically indicated in several scenarios, with specific patient selection criteria and expected outcomes. The procedure is typically recommended when kidney stones are larger than 2 cm in diameter, when stones form a staghorn pattern blocking multiple branches of the kidney’s collecting system, when large stones are present in the ureter (the tube connecting the kidney to the bladder), or when other less invasive therapies have failed.1
The surgical procedure involves several key steps: First, the patient is placed under general anesthesia. A specialized needle is inserted through the skin into a urine-collecting chamber of the kidney (calyx) under imaging guidance.1 This needle path becomes the passage for the remainder of the procedure. A tube (sheath) is placed along this path, through which specialized instruments are passed to break up and remove the stones.1 In some cases, a nephrostomy tube may be left in place temporarily to allow urine drainage directly from the kidney during recovery.1
Patient selection criteria include consideration of stone size, location, composition, and previous treatment history. Patients with bleeding disorders, active urinary tract infections, or anatomical abnormalities may require special consideration.2 The expected recovery timeline typically involves a hospital stay of 1-2 days, with avoidance of heavy lifting and strenuous activity for 2-4 weeks.1 Most patients can return to work after approximately one week.1
Success rates for PCNL are generally high, with studies reporting stone-free rates of 75-80% for standard cases.3 However, factors such as stone location can significantly impact outcomes, with lower calyx stones showing reduced clearance rates (approximately 50%) compared to upper or mid-calyx stones.3 Complication rates are approximately 15-20%, with the majority being minor (Clavien-Dindo Grades I-II).3 Major complications (Grades III-IV) occur in approximately 4-5% of cases.3