Successful PCNL for Large Left Renal Calculus in a Middle-Aged Male from Sikar, Rajasthan
Kidney stones, medically referred to as renal calculi, are among the most prevalent urological conditions in adults. When these stones grow beyond 2 cm in size, conservative or non-invasive treatments often fall short, necessitating advanced surgical techniques for effective removal. One of the most widely accepted and successful procedures for such cases is Percutaneous Nephrolithotomy (PCNL)—a minimally invasive surgery designed to clear large renal stones with precision and minimal trauma to surrounding tissues.
At the Institute of Urology, Jaipur, a centre of excellence in urological care with a proud legacy of over 30 years, PCNL is routinely performed by a team of seasoned urologists with outstanding outcomes. This case highlights one such successful intervention.
Case Summary
A 45-year-old male presented to the outpatient department at the Institute of Urology, Jaipur, with complaints of dull, persistent left flank pain for the past several weeks, accompanied by occasional episodes of nausea and mild hematuria. The patient had no significant comorbidities, but the intensity of symptoms had increased, affecting his daily routine.
Clinical Examination and Investigations
Upon clinical examination and detailed history-taking, the patient was advised a non-contrast CT scan (NCCT KUB) which revealed a large, dense stone in the left renal pelvis extending into the lower calyx. Routine blood work, including renal function tests, was within normal limits. Urinalysis showed microscopic hematuria but no evidence of infection.
Given the size and location of the stone, the patient was counseled for Percutaneous Nephrolithotomy (PCNL) as the most suitable treatment option.
Why PCNL Is the Preferred Approach for Large Stones
For stones larger than 2 cm, especially those located in the renal pelvis or involving multiple calyces, PCNL is globally recognized as the gold standard treatment. Compared to other methods such as Shockwave Lithotripsy (ESWL) or Retrograde Intrarenal Surgery (RIRS), PCNL offers significantly higher stone clearance rates in a single session and is particularly effective for complex or staghorn calculi.
According to the American Urological Association (AUA) guidelines, PCNL is recommended as the first-line therapy for renal stones greater than 20 mm, providing excellent results in terms of safety, stone-free rates, and patient recovery. Recent studies have also shown that PCNL leads to fewer retreatments, making it a cost-effective and durable option in the long term.
Surgical Procedure
The patient underwent PCNL under general anaesthesia. The procedure was meticulously performed by Dr. M. Roychowdhury and Dr. Rajan Bansal, two of Jaipur’s most reputed urologists with decades of combined experience in managing complex urological cases. Under fluoroscopic guidance, a percutaneous tract was established to access the stone through a small incision in the flank.
A nephroscope was introduced to visualise the calculus directly. Using the latest high-powered laser lithotripter, the stone was fragmented into fine pieces and evacuated completely. Post-operative nephrostomy was placed to facilitate drainage and healing.
Post-operative Outcome
The patient tolerated the procedure exceptionally well. Post-operative ultrasound revealed no residual stone fragments or complications. He was discharged on the third post-operative day in a stable condition and was advised routine follow-up.
At his 2-week follow-up visit, the patient reported complete relief of symptoms and resumed normal activity. Imaging confirmed a completely stone-free status, validating the success of the procedure.
Discussion
This case exemplifies the clinical judgement and surgical precision required in managing large renal calculi. The PCNL technique, although technically demanding, remains the most effective intervention for stones >2 cm. With the availability of ultra-modern laser machines, advanced imaging modalities, and highly trained operation theatre staff, outcomes are predictable and consistently excellent at our facility.
Moreover, the Institute of Urology, Jaipur, has built a rock-solid reputation over the last 30+ years for excellence in patient care, especially in urology. The centre is equipped with state-of-the-art technology and world-class infrastructure, offering patients a seamless experience—from diagnosis to recovery.
The procedural success in this case is also a testament to the clinical acumen of Dr. M. Roychowdhury, whose distinguished experience of more than three decades in urology has led to the successful treatment of thousands of kidney stone cases, and Dr. Rajan Bansal, a rising expert known for his surgical finesse and patient-first approach.
Conclusion
Managing large kidney stones requires precision, experience, and access to the right technology. In this case, PCNL emerged as the most reliable and definitive treatment, and it was executed with remarkable expertise at the Institute of Urology, Jaipur.
Patients across Rajasthan and neighbouring states trust Dr. M. Roychowdhury and Dr. Rajan Bansal for their unwavering commitment to patient outcomes, compassionate care, and mastery in handling even the most complex urological disorders. Backed by a legacy of excellence, modern infrastructure, and comprehensive in-house diagnostic and surgical services, the Institute of Urology continues to be the best hospital for the treatment of kidney stones and a wide spectrum of urological diseases in Jaipur, Rajasthan.
