Percutaneous nephrolithotomy (PCNL) in emergency urology

Key points

PCNL is the principal endourological treatment for a substantial renal stone burden (large and staghorn stones).

In an emergency, distinguish between:

• percutaneous nephrostomy, PCN: urgent drainage of the urinary system;
• percutaneous nephrolithotomy, PCNL: definitive stone removal.

Before intervention

• Assess infection status.
• Coagulation profile, hemoglobin, kidney function.
• Collecting system anatomy.
• In active infection, drainage and sepsis treatment come first.

Technique and strategy

• Image-guided access.
• A staged approach is acceptable for a large stone burden.
• Goal: effective stone removal while minimizing bleeding, parenchymal injury, and infectious complications.

Complications

• Bleeding (the most significant).
• Fever/sepsis.
• Injury to adjacent organs.
• Extravasation.
• Residual fragments.

In hemodynamically significant bleeding, obtain early imaging of the vascular source and perform angioembolization when indicated.

Postoperative management

• Monitor vital signs, urine output, hemoglobin, and creatinine.
• Assess residual stone burden.
• Plan the second stage when using a staged approach.

Algorithm