Techniques
Percutaneous nephrolithotomy (PCNL) passes a working channel from the flank into the kidney. Through that channel, ultrasonic lithotripsy applies high-frequency vibration with suction, while pneumatic lithotripsy delivers impact energy similar in concept to a small jackhammer. Holmium laser is frequently used as well.
For large kidney stones (generally greater than 2 cm) and staghorn stones, PCNL is the recommended first-line approach in both EAU (2025) and AUA (2026) guideline frameworks, with AUA 2026 citing moderate recommendation and Grade B evidence for that position. PCNL is also preferred when flexible ureteroscopy is unlikely to achieve complete clearance of complex calyceal stone burdens.
As summarised on the Urology NSW kidney stone page, the stone is broken and removed piece by piece using combinations of ultrasonic and pneumatic lithotripsy and the holmium laser. Ultrasonic handpieces can aspirate debris at the same time, which helps clear stone mass efficiently during long cases.
Patients typically stay one to two nights. A drain or nephrostomy tube may be left for a short period. Heavy lifting is usually limited for several weeks. Bleeding requiring transfusion is an important specific risk because the tract passes through renal parenchyma; infection, adjacent organ injury, and staged second procedures are also recognised possibilities discussed in guideline patient counselling themes.
See Percutaneous (keyhole) removal of stones from kidney (BAUS).
The rooms can arrange a consultation to review imaging and outline which form of lithotripsy, if any, fits your situation.