Medically reviewed by Harsha Moole, MD, Internal Medicine. Last reviewed: October 23, 2026.
Which doctor performs percutaneous nephrolithotomy (PCNL)?
Percutaneous nephrolithotomy, a procedure that removes large kidney stones through a small opening in the back, is performed by a urologist (urinary tract doctor). A direct primary care or concierge doctor does not perform this procedure and instead refers patients to a urologist for evaluation and the surgery itself. Afterward, your primary care doctor can help manage recovery and follow-up.
What it is
Percutaneous nephrolithotomy, also called PCNL, is a procedure to remove kidney stones. The surgeon passes a special medical instrument through your skin into your kidney. The surgeon uses a thin viewing tool, called a nephroscope, to find and remove the kidney stone. The tool goes into the kidney through a small cut made in your back.
Why a doctor might recommend it
Reasons to have this kind of procedure include the following.
- Your flow of urine is blocked.
- X-rays show the kidney stone is too large to pass by itself or to be treated by going through the bladder to the kidney.
- The kidney stone is causing urinary tract infections.
How to prepare
Common preparation steps include the following.
- Tell your surgeon or nurse if you are or could be pregnant.
- Tell your surgeon or nurse about any medicines, supplements, or herbs you take, including ones you bought without a prescription.
- If you smoke, it is important to cut back or quit. Smoking can slow healing and increase the risk for blood clots.
- During the week before the procedure, you may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. Ask your surgeon which medicines you should still take on the day of the procedure.
What happens during it
You will receive general anesthesia so that you will be asleep and feel no pain. The surgeon makes a small cut (incision) on your back. A needle is passed through the skin into your kidney. The surgeon uses instruments to take out the stone or break it into pieces. For larger stones, the doctor may also use a laser to break the stone into smaller pieces. After the procedure, a tube is placed in the kidney (nephrostomy tube). Another tube, called a stent, is placed in the ureter to drain urine from your kidney. This allows your kidney to heal.
Recovery
You may be able to go home within 24 hours. You may have to stay in the hospital for several days after the procedure. The surgeon will take out the tubes if x-rays show that the kidney stones are gone and your kidney has healed. If stones are still there, you may have the same procedure again soon.
You may have some pain in your back for the first week after the tube is placed in the kidney.
Contact your provider if you have any of the following.
- Pain in your back or side that will not go away or is getting worse.
- Blood in your urine after the first few days.
- Fever and chills.
- Urine that smells bad or looks cloudy.
- Worsening redness or pain of the skin around the tube.
Call 911 or go to the emergency room if you have bleeding that will not stop, trouble breathing, chest pain or discomfort lasting two minutes or more, or fainting.
Risks and side effects
The procedure is generally safe, but ask your surgeon about these possible complications.
- Pieces of stone may be left in your body, and you may need more treatments.
- Bleeding around your kidney.
- Problems with kidney function, or kidneys that stop working.
- Pieces of the stone may block urine flow from your kidney, which may cause very bad pain or kidney damage.
- Kidney infection.
Who performs it
A urologist, a doctor who treats the urinary tract, performs this procedure.
Common questions
When is PCNL needed instead of other stone treatments?
PCNL is usually used for kidney stones that are too large to pass by themselves or to be treated by going through the bladder to the kidney. A urologist decides which option fits your stone size, location, and overall health.
Do I need a referral to see a specialist for kidney stone removal?
Most people are referred to a urologist by their primary care or concierge doctor after imaging confirms a stone that needs a procedure. The primary care doctor can start this referral once the stone is found.
What is recovery like after PCNL?
Recovery from PCNL usually involves a hospital stay, which may be as short as 24 hours or last several days. Your surgeon will take out the tubes if x-rays show that the stones are gone.
Sources
- MedlinePlus - Percutaneous kidney procedures
- MedlinePlus - Percutaneous urinary procedures - discharge
- National Institute of Diabetes and Digestive and Kidney Diseases - Treatment for Kidney Stones
Medical Disclaimer
This content is for general educational and informational purposes only and is not medical advice. It is not a substitute for professional medical advice, diagnosis, or treatment, and reading it does not create a doctor-patient relationship. Always seek the advice of your physician or another qualified health provider with any questions about a medical condition, and never disregard or delay seeking professional advice because of something you read here. If you think you may have a medical emergency, call 911 (or your local emergency number) immediately.
