Another treatment option is called a percutaneous nephrolithotomy (PCNL). This surgery is recommended if the stone is too large or located in a place in the urinary tract that may not allow for effective ESWL results. The Urologist inserts fiber optic endoscopes called a Nephroscope (through a tiny incision). This allows the urologist to view the stone inside the kidney. Smaller stones can be grasped and removed. Larger stones may need to be broken up by an electro hydraulic or ultrasonic energy or Laser probe.

Patients have a tube called a nephrostomy tube inserted through a small incision in the flank and into the kidney after the treatment to help drainage. The patient will need to stay in the hospital for a few days with the nephrostomy tube in the back during healing. Once the nephrostomy tube is removed, the incision and kidney will heal in a few days, and the patient can return to normal work and usually within one week. One advantage PCNL has over ESWL is that the stones are broken and removed in most cases at the time of the surgical procedure.