Is it a Large Kidney Stone?

Large Kidney Stones - What you Can do to Find Relief

Stones _singleAnyone who has ever had a kidney stone can attest to the fact that they can be painful - really painful.

While some stones are small enough to not even cause symptoms, and other smaller kidney stones can be passed through the urinary system with just a bit of help from over the counter pain medication and lots of water, other stones are too large to handle and must be surgically removed.

You may ask, 'how will I know if I have a large kidney stone?'

"You'll know," says Julio Davalos, M.D. Director of the Kidney Stone Program at Chesapeake Urology and one of the few surgeons in the country experienced at the tubeless PCNL procedure to remove large kidney stones. "The larger the kidney stone, the more noticeable the symptoms. With large stones, patients experience pain in the back or side and pain can be intense. Immediate care by an experienced urologist is imperative when a large kidney stone is present."

Kidney stones that are too big to move through the urinary tract cause irritation and blockages of urine that are painful. Because stones are actually crystals, some larger kidney stones may have jagged edges that further irritate the kidney. 

Finding Relief and Becoming Stone-Free


Over the past several years, there have been a number of advancements in large kidney stone treatment including the surgical removal of large kidney stones using a complex, yet minimally invasive technique, called Percutaneous Nephrolithotomy or PCNL and Tubeless PCNL.

What is PCNL/Tubeless PCNL?

PCNL and Tubeless PCNL are minimally invasive procedures for the removal of large and complex kidney stones. PCNL is used to remove kidney stones that are larger than 2cm in diameter and cannot be passed through the urinary tract. Percutaneous refers to a minimally invasive surgical technique performed via a small incision through the skin, rather than an open, more invasive procedure.

PCNL is indicated for patients who have failed other kidney stone treatments like SWL or ureteroscopy, or for stones that are too large to pass or be treated through non-surgical measures. 

How it Works

In standard PCNL, a tube called a nephrostomy tube is placed into the kidney where the stone is located by an interventional radiologist prior to the surgery. The tube allows the surgeon to gain access into the kidney to remove the large stone during the procedure. Through this tube, the surgeon 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. In some patients, the nephrostomy tube remains for several days to one week following surgery to allow for drainage and is removed by your surgeon. 

Learn more about PCNL here. 

Read: PCNL Surgery - Step-by-Step

Tubeless PCNL- A Standard of care

The tubeless PCNL procedure is performed as a PCNL surgery; however, the surgery eliminates the need for the nephrostomy (drainage) tube, which exits the surgical site through the skin and is used to drain excess fluid from the kidney such as urine and blood post-operatively, or provide access if re-entry into the kidney is necessary.

Rather than leaving the drainage tube in the patient following extraction of the stone, the renal access tract leading from the outside of the body (the skin, or percutaneous) through to the kidney is sealed using a specially designed plug. 

Tubeless PCNL is not indicated for every patient - your surgeon will determine if you are an appropriate candidate. 

The advantages of tubeless PCNL include:

  • Minimized post-operative pain.
  • No leakage of fluids from the nephrostomy tube (urine, blood), which is replaced instead by an internal plug.
  • A quicker recovery following the tubeless PCNL procedure.
  • Shorter length of hospital stay.
  • Some cases may be performed in a specially-equipped ambulatory surgery center as a same-day procedure for appropriate candidates.

Learn more about tubeless PCNL here. 

Learn more about PCNL, Tubeless PCNL, large kidney stones and why experience in treatment for large kidney stones matters for long term health - visit  for the latest information on diagnosis, advanced treatment and prevention of large kidney stones.