Percutaneous nephrolithotomy is a procedure that is used for the removal of kidney stones that are too large – usually larger than 2 centimeters –  to pass through the urethra. Patients who are suffering from abnormal kidney stones, having an infection, or the stones have not been broken up to small pieces by the body are candidates for this type of treatment. In the past, urethra or kidney stones were removed by open surgeries that required to make an incision in the hips. However, the size of the incision made by percutaneous nephrolithotomy is less than 1cm, and there is no pain or blood involved, which are some of the benefits of this procedure.

Before the surgeon decides that a patient needs to undergo Percutaneous Nephrolithotomy, the patient should obtain X-ray films or any report, including, CT scan, MRI, and sonogram. At Medova, your surgeon, before giving the final diagnosis, will discuss all the options and risks that are involved for the removal of kidney stones, so patients can feel assured that they are the right candidate for percutaneous nephrolithotomy.

• A large stone blocks more than one branch of the collecting system of the kidney. 
• Patients who have stones that are larger than 2 centimeters. 
• Large stones that are found in the ureter (a tube that carries urine from the kidney to the urinary bladder). 

Patients with large kidney stones should be hospitalized if they want to undergo percutaneous nephrolithotomy. In order to access the kidney stone, the patient will be taken to the radiology department to use CT, ultrasound, or X-ray imaging. Also, the procedure requires patients to receive a general anesthetic which means they will be unconscious during the procedure and will feel nothing. Alternately, the surgeon may use x-ray imaging during the main operation by inserting a tube into the kidney. 

The doctor, with the help of x-ray imaging, will make a puncture in the kidney to remove the stones. Subsequently, when the doctor feels confident that he/she has reached the enlarged stones in the kidney, a small sheath will be sent into the kidney, and using special instruments, enlarged stones will be broken down. Afterward, the residues of larges stones will be removed by the doctor and will be sent to the lab for further analysis.

Percutaneous Nephrolithotomy is considered a minimally invasive procedure; however, below, some of the most common complications will be provided:

• Infection.
• Bleeding.
• Damage to the kidney or other organs.
• Stones have not been wholly obliterated. 

• To relieve any pain following the procedure, patients may be required to take medication.
• Patients should dry nephrostomy tube (a tube that drains the urine) after showering. 
• To minimize blood clots, a daily walk is highly advised. 
• Ureteral stent will be removed after 1 to 2 weeks.

Percutaneous nephrolithotomy is a type of surgery that should be performed only in hospitals; therefore, it is of paramount importance that facilities and equipment are in accordance with the global standard for quality health. The reason why many patients around the world choose Iran to follow their health treatment is not only because of the well-equipped hospitals but also Iran boasts some the most professional doctors who are practising medicine and offering innovative solutions in countries like the USA and Canada. Furthermore, each year Iranian urologists from Tehran University of Medical Sciences publish new research that provides invaluable outcome and opportunities in various medical fields that can offer patients the most suitable treatment.