Boston Scientific Logo

Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is a preferred treatment for large stones within the kidney or upper ureter. The procedure involves making a small incision (1 cm) in the back overlying the location of the kidney. A tunnel is then created from the skin into the kidney to allow passage of a telescope. The telescope is used to locate the existing stone and any small stones that may not have been visible by X-ray. The telescope has an inner channel that allows passage of instruments that are used to break up the stone.
Contact Us About This Procedure

Healthcare Professionals

Percutaneous nephrolithotomy (PCNL) provides the urologist with an important treatment option for patients with:
  • Stones located in the kidney
  • Stones accompanied by urinary tract anomaly
  • Stones in locations that preclude effective ESWL or endoscopic retrieval
A wide variety of instrumentation is required for percutaneous nephrolithotomy. Each case will present unique challenges. It is imperative that instrumentation is properly selected to match the requirements of the case.

A selection of Boston Scientific instruments can be used for percutaneous access to the urinary tract for stone retrieval and the establishment of nephrostomy drainage.

The following phases in a PCNL procedure can be identified:
  1. Access: guidewire
  2. Dilatation: balloons and access sheaths
  3. Retrieval: baskets, lithotripsy devices
  4. Drainage: catheters
PCNL typically includes the following steps:
  1. Advance guidewire and occlusion balloon A guidewire is advanced retrograde into the renal pelvis. An occlusion balloon is advanced to the desired position. The guidewire is removed and the balloon is inflated.
  2. Opacify the collecting system The collecting system is opacified with a retrograde injection of contrast solution. Air can be injected to aid in identifying posterior calyces.
  3. Puncture calyx and place guidewire: An 18 gauge, 2 piece entry needle is advanced in a straight pathway into the selected calyx and the inner stylet is removed. Aspiration of contrast material and/or urine through the cannula confirms access to the collecting system. The balloon is deflated and a guidewire advanced through the cannula into the kidney and down the ureter.
  4. Place guidewire: difficult anatomy: If entering the ureter proves difficult, torqueable catheters can be used to direct the guidewire into the ureter. First, a dilator is passed over the Glidewire Guidewire. Then a catheter is used to access the ureter. Now the guidewire can be advanced down the ureter.
  5. Place second guidewire: After successful access is established, the Glidewire Guidewire should be exchanged for an Amplatz Super Stiff™ Guidewire. This can be done using a 9/10 Co-axial Dilatation Set. The dilator/sheath assembly is advanced over the Glidewire Guidewire and into the ureter. The 8 French dilator is then removed from the sheath. A .035” Amplatz Super Stiff Guidewire can now be introduced throught the 10 French sheath and advanced into the bladder. The Glidewire Guidewire is then removed.
  6. Advance balloon over wire: The precutaneous nephrostomy track is created with a NephroMax™ High Pressure Balloon Catheter and a 30 French PTFE Sheath. The sheath is preloaded onto the NephroMax High Pressure Balloon Catheter. The NephroMax High Pressure Balloon Catheter is advanced over the Amplatz Super Stiff Guidewire until the distal tip of the balloon is positioned in the calyx.
  7. Dilate track: Inflate balloon: The balloon is then inflated using either the LeVeen™ or Encore® Inflator. The balloon is inflated with a 50% solution of sterile saline and contrast media to a minimum of 12 ATM. The balloon is left inflated until the “waist” disappears.
  8. Perform nephroscopy: Nephroscopy and be performed through the PTFE sheath. The Amplatz Super Stiff Guidewire should be removed once nephroscopy has confirmed satisfactory location of the PTFE Sheath in the calyx. The shaft of the Amplatz Super Stiff™ Guidewire could injure the endothelial lining of the collecting system duting manipulations of the nephroscope, subsequent lithotripsy and stone fragment retrieval. Both rigid and flexible nephroscopes can be introduced through the PTFE Sheath.
  9. Perform lithotripsy: Lithotripsy can be performed with the Swiss Lithoclast® Ultra Pneumatic Lithotripter or the Holmium Laser.
  10. Remove stone fragments: Remove stone fragments using stone retrieval devices such as a basket or a forceps.
  11. Place nephrostomy drainage catheter: Finally, a Re-Entry Malecot Nephrostomy Catheter or a Flexima® Locking Loop Nephrostomy Catheter is placed to establish urinary drainage. The Amplatz Super Stiff Guidewire is reintroduced through the PTFE Sheath and advanced into the bladder. The extra stiffness of this guidewire facilitates advancement of the Re-Entry™ Malecot Nephrostomy Catheter of the Flexima Locking Loop Nephrostomy Catheter. The Stiffener supplied with the nephrostomy catheter is used to straighten the malecot wings. The PFTE Sheath and Amplatz Super Stiff Guidewire are then removed. Swiss Lithoclast is a registered tademark of Electro Medical Systems SA


    See Prescriptive Information regarding specific Boston Scientific product indications, contraindications, precautions and warnings. Please refer to Directions for Use for more complete information.

Image Gallery
1. Advance Guidewire and Occlusion Balloon 10. Remove Stone Fragments 11. Place Nephrostomy Drainage Catheter 2. Opacify the Collecting System