Percutaneous nephrolithotomy is a technique that may be used to remove stones from the kidney or upper ureter. It avoids the morbidity of an open procedure.
A needle is passed through the skin into the renal pelvis under ultrasound or radiological guidance. A guide-wire is then threaded through the needle into the kidney to create a track. Using graduated dilators, the track is then enlarged to a diameter of approximately 30 mm. The stone may then be removed immediately or following drainage for 48 hours with a nephrostomy tube.
Small stones can be removed through the nephrostomy track under direct vision using special nephroscopes and a variety of grasping instruments. Stones larger than the tract must be fragmented prior to removal, either with ultrasound or electrohydraulic probes.
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