The gold-standard treatment for large kidney stones
Percutaneous Nephrolithotomy (PCNL) is the most effective way to remove large kidney stones (>2cm) or complex staghorn stones — accessed through a small incision in the back using specialized instruments. Performed at Prestige Medical Group by Dr. Hari Sawkar, MD — a board-certified urologic surgeon with expertise in minimally invasive stone surgery.
What is PCNL surgery?
Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgical technique for removing large kidney stones — typically stones larger than 2 centimeters, staghorn stones filling the kidney’s collecting system, or stones that haven’t been successfully treated by other approaches. The procedure is performed under general anesthesia through a small incision (about 1 cm) in the flank/back.
Using specialized instruments passed through the small incision, Dr. Sawkar accesses the kidney directly, fragments the stone using laser or ultrasonic energy, and removes the pieces — all through the same small opening. Compared to older open surgical approaches, PCNL offers dramatically smaller incisions, less blood loss, less pain, and faster recovery — while still achieving the highest stone-free rates of any minimally invasive stone treatment.
At Prestige Medical Group, PCNL is performed exclusively by Dr. Hari Sawkar, MD — a board-certified urologic surgeon with subspecialty expertise in minimally invasive stone surgery. His combination of biomedical engineering training and high-volume stone surgery experience translates directly to precise, efficient technique.
Dr. Hari Sawkar, MD
Dr. Sawkar’s expertise in minimally invasive stone surgery spans the full spectrum — from ureteroscopy and holmium laser lithotripsy for smaller stones to PCNL for the largest and most complex cases. His high case volume across the range of stone situations means he can match the right technique to each patient’s stone burden and anatomy.
Who is a candidate for PCNL?
PCNL is the treatment of choice for kidney stones that are too large or complex for other minimally invasive approaches to clear reliably.
Large kidney stones (>2cm)
Stones larger than 2 centimeters are generally not efficiently cleared by shockwave lithotripsy or standard ureteroscopy. PCNL is the gold-standard approach.
Staghorn calculi
Complex stones that fill the kidney’s branching collecting system (shaped like antlers) — these are difficult to treat with any other technique.
Failed prior treatment
Stones that haven’t cleared after shockwave lithotripsy (ESWL) or ureteroscopy — where a definitive, high-efficiency approach is needed.
Complex anatomy
Patients with unfavorable anatomy for other approaches — such as certain congenital variations or after prior urologic surgery.
How PCNL compares to other stone treatments
Prestige offers a full range of kidney stone treatments. The right approach depends on stone size, location, composition, and your specific anatomy.
Watchful waiting (very small stones)
Some very small stones (<4mm) may pass naturally with hydration and pain management. Not all stones require intervention.
Shockwave Lithotripsy (ESWL)
External shockwaves fragment smaller stones — non-invasive, no incisions, but less effective for larger, harder, or lower-pole stones.
Ureteroscopy with laser lithotripsy
A thin scope passed through the natural urinary tract to fragment and remove stones with holmium laser — ideal for smaller stones or ureteral stones.
PCNL (Percutaneous Nephrolithotomy)
The gold-standard for large (>2cm), staghorn, or complex kidney stones — highest stone-free rate in a single procedure.
The three steps of PCNL
PCNL combines three sophisticated techniques to access, fragment, and remove even the largest kidney stones through a small incision.
Precision kidney access
Using X-ray or ultrasound guidance, a small needle is passed through the skin of the flank directly into the kidney’s collecting system. The tract is then dilated to allow instruments to pass.
Stone fragmentation
Through the small tract, a nephroscope is inserted along with an energy source — typically a holmium laser or ultrasonic lithotripter — to break the stone into removable pieces.
Fragment removal
Stone fragments are extracted through the same tract. A temporary tube (nephrostomy) may be left in place for a day or two to help drainage as the kidney heals.
What to expect on surgery day
PCNL is performed under general anesthesia and typically takes 1-3 hours depending on stone burden. Most patients stay in the hospital 1-2 nights.
Consultation & workup
Dr. Sawkar reviews CT imaging, discusses your stone characteristics, and confirms PCNL as the right approach. Preoperative labs and testing are arranged.
Surgery day
Under general anesthesia and imaging guidance, Dr. Sawkar creates a small tract to the kidney, fragments the stone with laser or ultrasonic energy, and removes all fragments — typically 1-3 hours.
Hospital recovery
Most patients spend 1-2 nights in the hospital while pain is managed and the kidney recovers. A temporary drainage tube may remain in place briefly.
Home & follow-up
Discharged with clear recovery instructions. Follow-up imaging confirms stone clearance and monitors healing. Most patients are back to work within 1-2 weeks.
What recovery looks like
PCNL recovery is significantly faster and easier than traditional open kidney surgery — though it does involve a brief hospital stay and gradual return to activity.
PCNL questions answered
Have a question not answered here? Call (949) 825-7650 to speak with our team.
Why not just use shockwave lithotripsy?
How is PCNL different from open kidney surgery?
Will I be stone-free after one procedure?
How long is the hospital stay?
What are the risks?
Who performs PCNL at Prestige Medical Group?
How can I prevent future kidney stones?
Ready to get treated?
Large kidney stones don’t have to mean open surgery — and they don’t have to mean multiple failed shockwave sessions. Dr. Sawkar will review your imaging, discuss your options, and help you choose the approach with the best chance of stone-free results. Schedule a consultation today.