About PCNL - A Step-By-Step Look at the Procedure


Snapshot Of PCNL

  • When it is time for your PCNL surgery, a member of the surgical team will bring you back to the procedure room where you will receive anesthesia.

  • You will be turned, face down on the operating room table (prone position). You will be placed on a specialized bed designed for prone surgery.

  • A small tube will be placed from below up to the kidney to allow for precise visualization of the kidney using real-time X-rays.

  • Once the location of the stone is mapped, Dr. Davalos makes a small, 1 cm (about 1/2 an inch) incision in the back.

  • A small tube is placed into the drainage system of the kidney close to the stone being treated. X-ray imaging called fluoroscopy is used to help guide the precise placement of the tube into the kidney.

  • A wire is then passed into the kidney and a balloon is used to dilate a tract.

  • A tube is placed over the balloon and a scope is inserted into the tract to look into the kidney.

  • Through this tube, Dr. Davalos inserts a small telescope for visualization of the stone as well as specialized instrumentation that is used to break up the kidney stone(s) into very small pieces, which are then cleared from the kidney. The goal is to clear all stones and fragments from the kidney.

  • Once the stones are removed, it is not uncommon to place a small tube down the ureter and into the bladder to allow the kidney to drain better while it heals from the procedure.

  • Rarely, a tube is left in the kidney (called a nephrostomy tube) to allow for additional drainage. At present, Dr. Davalos performs more than 95% of these procedures with a tubeless technique This means that a vast majority of the time a nephrostomy tube is not placed at the end of the procedure. 

    If necessary, the nephrostomy tube is placed into the surgical site and exits through the skin. This tube is utilized for drainage of urine and blood and is typically removed in about three days following surgery.

  • Stones will be sent for analysis to aid in developing a program to prevent further stone formation.


Tubeless PCNL is the standard treatment of care for patients deemed appropriate candidates. This eliminates the need for the nephrostomy tube post-operatively, resulting in less discomfort and quicker recovery for many patients.

In fact, most patients who had a tubeless PCNL performed by Dr. Davalos have reported little pain after the procedure and little to no need for pain medication. 

Learn More About Tubeless PCNL Here. 


What are the advantages and risks associated with PCNL? Learn more. 

What To Expect Before and After PCNL Surgery.