Percutaneous nephrolithotomy is a surgical procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size. It is usually done under general anesthesia or spinal anesthesia.

Procedure
A Retrograde pyelogram is done to locate the stone in the kidney. With a small 1 centimeter incision in the loin, the Percutaneous nephrolithotomy (PCN) needle is passed into the pelvis of the kidney. The position of the needle is confirmed by fluoroscopy. 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 The needle is then withdrawn with the guide wire still inside the pelvis.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

• Hydrothorax if PCNL is done through 11th intercostal space

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