Percutaneous Nephrolithotomy (PCNL) is a procedure to remove large kidney stones through a small incision in the back. While effective, understanding what to expect after surgery is an important part of preparing for the procedure and ensuring a smooth recuperation.
The Immediate Post-Surgery Period
After waking from anesthesia, most patients have a one to two-night hospital stay. The focus during this time is managing pain and monitoring the urinary system. Pain in the flank or back is expected and is controlled with intravenous medications or a patient-controlled analgesia (PCA) pump, which allows you to administer a dose of pain relief as needed.
You will have one or two tubes in place after the surgery. A nephrostomy tube is inserted through the incision in your back directly into the kidney. This tube drains urine and any blood into an external bag, allowing medical staff to monitor kidney function. A urinary catheter is also placed into the bladder to drain urine, which will likely appear blood-stained initially. Both tubes are temporary and are removed before or shortly after you go home.
Common Experiences During Home Recovery
Once home, recovery continues for several weeks with some normal experiences. It is common to feel discomfort at the small incision site, which can be managed with prescribed pain medication. You should expect to see some blood in your urine, with the color ranging from pink to reddish. It may fluctuate, becoming more noticeable after physical activity, but should gradually clear over a week or two with adequate hydration.
Many patients have a temporary ureteral stent placed inside the urinary tract to ensure the kidney drains properly. The stent can cause a feeling of bladder fullness, a frequent or urgent need to urinate, and bladder muscle spasms. A burning sensation during urination is also a common complaint, but these symptoms resolve once the stent is removed by your doctor.
Warning Signs of Serious Complications
While managing expected discomforts is part of recovery, it is important to know the signs of serious complications. A fever higher than 101°F (38.3°C) with chills can indicate an infection and requires immediate contact with your doctor. Infections can also present with cloudy or foul-smelling urine or increased redness and pain around the incision site.
Significant bleeding is not a normal part of recovery. If your urine becomes thick with blood, appears ketchup-like, or you are passing large blood clots, seek immediate medical evaluation. Severe pain not controlled by your medication or the inability to pass urine are also urgent issues that require prompt medical attention.
Long-Term Outlook After PCNL
The small incision on your back will heal, leaving a minimal scar. Most individuals can resume normal, non-strenuous activities within one to two weeks, though your surgeon will provide specific guidance based on your recovery progress. Strenuous activities and heavy lifting will need to be avoided for a longer period. Follow-up appointments are scheduled to monitor your healing and, if necessary, remove the ureteral stent. For the vast majority of patients, the procedure successfully removes the targeted kidney stones without causing any long-term negative impact on overall kidney function.