Prof. Dr. Emel Akoğlu
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Kidney Stones
Percutaneous nephrolithotomy
What percutaneous nephrolithotomy (PCNL) is, why it is the usual operation for large or complex kidney stones, how the nephroscope and laser break and remove the stone, how it compares with shockwave lithotripsy and ureteroscopy, approximate costs in Turkey against the UK, US and Germany, hospital stay and recovery, risks and how to check a urology team.
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Prof. Dr. Zerrin Biçik Bahçebaşı
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Percutaneous nephrolithotomy in Turkey: what it is and when it is used
Percutaneous nephrolithotomy, usually shortened to PCNL, is a keyhole operation to remove large kidney stones through a small cut in the back, about 1 cm wide. A narrow channel is made directly into the kidney, a thin telescope (a nephroscope) is passed along it, and the stone is broken up and the fragments taken out. "Percutaneous" means through the skin; "nephro" means kidney; "lithotomy" means stone removal. It is the standard operation for stones that are too large or too hard for shockwave treatment or a telescope passed through the bladder, and it is performed routinely in Turkish urology departments.
This guide explains when PCNL is recommended, how the operation works, how it compares with other stone treatments, what it costs in Turkey against the UK, US and Germany, what the recovery is and what to ask a hospital. For other stone options, see our pages on kidney stone removal and the urology treatments in Turkey.
Who needs percutaneous nephrolithotomy rather than a gentler treatment?
PCNL is considered for stones larger than about 2 cm, for branched "staghorn" stones that fill the kidney's collecting system, for stones that are very hard or that did not break with shockwaves, and for stones in a kidney with unusual anatomy. European Association of Urology guidelines, like those of the American Urological Association, recommend it as the first-line choice for large stones in the kidney because it clears them more often and more completely than the alternatives. Smaller stones can usually be treated without a cut in the back. Your urologist should explain why PCNL, rather than a less invasive treatment, suits your stone, based on a CT scan that shows its size, position and density.
How does percutaneous nephrolithotomy work, step by step?
The operation is done under general anaesthesia and takes about one to two hours, longer for large or complex stones. First a thin tube (a ureteric catheter) is placed from the bladder to the kidney to help guide the procedure and, in many cases, to inject contrast. You are then turned onto your front or, in some hospitals, positioned on your back or side. Using X-ray or ultrasound, the urologist guides a needle into the kidney and enlarges the track to the size of the instrument being used.
The nephroscope is inserted along the track. The stone is broken up with a holmium laser, ultrasound or pneumatic lithotripsy, and fragments are suctioned out or removed with forceps. At the end a thin drainage tube (a nephrostomy tube) may be left in the kidney for a day or two, or the operation may be completed "tubeless" with only a ureteric stent. A stent that sits between the kidney and bladder is common and is removed a few days to weeks later.
PCNL, shockwave lithotripsy or ureteroscopy: how do they compare?
No technique is best for every stone. The choice depends on stone size, location and density, your anatomy and your health.
| Treatment | Best suited to | Typical limits |
|---|---|---|
| Percutaneous nephrolithotomy (PCNL) | Large, branched or hard kidney stones | Cut in the back; hospital stay; higher bleeding risk than the others |
| Shockwave lithotripsy (SWL) | Small to medium stones, up to about 2 cm | Less effective on hard or large stones; may need repeat sessions |
| Ureteroscopy with laser | Stones in the ureter and small to medium kidney stones | May need staging for larger stones; stent usually required |
For a ureteric stone, or a smaller kidney stone, a telescope passed through the bladder is usually tried first; see our guide to ureteroscopy. Smaller versions of PCNL ("mini-PCNL") use a narrower track and may reduce bleeding, though they can take longer on very large stones.
How much does percutaneous nephrolithotomy cost in Turkey compared with the UK, US and Germany?
The ranges below are approximate and not hospital quotes. The price depends on the size and complexity of the stone, the instruments and laser used, how many nights you stay, and whether scans and a stent removal are included. Each hospital confirms its price in a written quote.
| Country | Approximate cost range |
|---|---|
| Turkey | €3,000 – €8,000 |
| United Kingdom | €7,000 – €16,000 |
| United States | €12,000 – €32,000 |
| Germany | €6,500 – €15,000 |
A package normally includes the CT scan or review of your own, blood and urine tests, the operation and anaesthetist, two to four nights in hospital, the stent and its removal, medication and airport transfers. Ask whether treatment of a second stage or an unexpected infection is included.
What tests are needed before percutaneous nephrolithotomy?
A non-contrast CT scan of the kidneys is the standard test, because it shows the size, number and density of stones and the anatomy around the kidney. A urine culture is needed to exclude infection: operating on an infected kidney can cause severe illness, so any infection is treated with antibiotics first. Blood tests check kidney function, clotting and blood count. If you take a blood thinner, the doctor must plan when to stop it. The team may also ask about previous stones and request a metabolic assessment later to reduce the chance of new stones.
Is percutaneous nephrolithotomy painful, and what is the hospital stay?
You are asleep during the operation. Afterwards pain in the flank and around the tube is common and is controlled with painkillers, including local anaesthetic placed around the track by some surgeons. Most patients stay in hospital for one to three nights, depending on bleeding, the presence of a nephrostomy tube and whether a second look is planned. Blood in the urine for several days is normal. You are encouraged to walk the day after surgery and to drink plenty of water.
Some patients need a second procedure, for example a second PCNL or a ureteroscopy, to clear residual fragments. The surgeon should tell you at the outset whether this is likely and how it affects your time in Turkey.
Recovery after percutaneous nephrolithotomy: how long until you can fly and work?
Most people return to desk work after one to two weeks and to heavy lifting after four to six weeks. Flying is usually allowed once the nephrostomy tube is out, bleeding has stopped, and the surgeon has checked a scan or X-ray, often at about five to ten days. If a stent is left in, it is removed or exchanged at a short visit, so plan this before you travel or arrange it with a urologist at home.
| Period | What to expect |
|---|---|
| Days 1–3 | Hospital stay; flank pain; blood in urine; tube or stent |
| Days 5–10 | Check scan; stone-free status reviewed; fit to fly if clear |
| Weeks 2–4 | Stent removed if present; desk work; avoid heavy lifting |
| Weeks 4–6 | Return to full activity |
How successful is PCNL at clearing kidney stones?
Clearance rates for PCNL are higher than for shockwave treatment or ureteroscopy in large stones; for complex staghorn stones complete clearance is more demanding and may take more than one session. Success is defined as being free of stones or having only tiny fragments that pass without trouble, usually confirmed by a CT scan. Stones can come back: roughly half of people who have had a kidney stone form another over many years, according to the NHS and urological societies, which is why a diet and fluid plan, and sometimes a urine test to find the cause, are part of aftercare.
Risks and complications of percutaneous nephrolithotomy
Bleeding is the most common significant problem; a small proportion of patients need a blood transfusion or, rarely, an embolisation to stop it. Other risks include infection and, rarely, sepsis; fever; injury to the colon, spleen, liver or lung lining; urine leakage; and residual stone fragments. A urine infection before surgery raises the risk, which is why testing and treatment come first. Urological societies describe PCNL as safe when performed in experienced hands with proper pre-operative checks. Ask what the team does if bleeding or infection occurs and who treats you after you return home.
How do you choose a hospital for PCNL, and what should you ask?
Choose a urologist who performs PCNL regularly in a hospital with a CT scanner, intensive care and the ability to manage bleeding and infection. Red flags include no CT review before a quote, promises that every stone is cleared in one session, a price with no breakdown and no plan for stent removal. Read how our process works and send your scans through our free quote page. Questions to ask:
- Is PCNL really the right choice for my stone, or would ureteroscopy or shockwaves do?
- Do you plan standard or mini-PCNL, and will it be tubeless?
- How many PCNLs do you perform each year?
- What are the chances that I will need a second procedure?
- When will the stent be removed, and who does it if I am home?
Hospitals with Urology in Turkey
Frequently asked questions
It is a keyhole operation in which a narrow track is made through the back into the kidney, and a telescope is used to break up and remove large kidney stones. It is often shortened to PCNL.
Yes. It is recommended as the first-line treatment for stones larger than about 2 cm because it clears them more completely than shockwaves or ureteroscopy. Very complex stones may need more than one session.
Approximate ranges are €3,000 to €8,000 in Turkey, against about €7,000 to €16,000 in the UK. The price depends on stone complexity, hospital stay and what the package includes. The hospital confirms it in writing.
Most people stay one to three nights in hospital, return to desk work in one to two weeks and resume heavy lifting after four to six weeks. A stent may need removal after one to a few weeks.
You are under general anaesthesia during the operation. Afterwards there is flank soreness and discomfort from the tube or stent, which painkillers control, and blood in the urine for several days is normal.
It depends on the stone. PCNL suits large or hard kidney stones, while ureteroscopy suits ureteric stones and smaller kidney stones. The urologist should explain the choice from your CT scan.
The main risks are bleeding, infection, injury to nearby organs and residual fragments. Serious complications are uncommon when the operation is done in experienced hands after checking for infection.
A nephrostomy tube may stay for a day or two, or the operation may be tubeless. A ureteric stent is common and is removed later at a short visit, which you should plan before travelling.
Yes. Stones recur in many people over the years, so doctors advise drinking plenty of fluid, dietary advice and sometimes a urine test to find the cause.
Plan about five to ten days: one to three nights in hospital, then a check scan and tube or stent plan before you fly. Complex stones or a second stage may need longer.
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