Hospital Surgery · University Urology, PC
Percutaneous Nephrolithotomy (PCNL)
Surgical preparation and recovery guide for PCNL — a minimally invasive procedure for large or complex kidney stones performed through a small incision in the back.
Your surgery date and arrival time
Your surgery date and arrival time are listed in the written instructions provided by our office. If you have any questions about your date, arrival time, or where to go, please contact our office at (865) 305-9254 or the pre-op RN directly at (865) 440-1579 to clarify before your surgery day.
Please refer to the driving & parking instructions for this appointment
See Getting to UTMC for directions, parking, and registration instructions.
Pre-Anesthesia Testing
Pre-Anesthesia Consultation & Testing (PAT)
Before your surgery, you will have a Pre-Anesthesia Testing appointment at UTMC. This appointment ensures the day of surgery runs smoothly and safely.
What happens at your PAT appointment
- Full health history and physical exam
- Necessary lab work
- EKG and Chest X-Ray if age or medical conditions require
- Medication review — especially blood thinners and GLP-1 medications
What to bring
- Photo ID and insurance cards
- Complete medication list with dosages and timing (prescription and over-the-counter)
- Names and phone numbers of all specialists and your primary care physician
What to tell your doctor
- Any personal or family history of bleeding disorders or anesthesia reactions
Your PAT appointment date and time
Your Pre-Anesthesia Testing date and time are listed in the written instructions provided by our office. If you have any questions about your PAT appointment, please contact our office at (865) 305-9254 or the pre-op RN at (865) 440-1579.
Pre-Surgery Instructions
Medications & Fasting
Blood thinners
Stop as directed by your prescribing physician — typically 3–7 days before surgery.
- Plavix and Warfarin: Stop 7 full days before surgery (e.g., if surgery is Wednesday, stop after Tuesday’s dose the prior week)
- Xarelto and Eliquis: Stop 2 full days before surgery (e.g., if surgery is Wednesday, stop after Sunday’s evening dose)
GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound, etc.)
Stop 7 days prior to surgery.
SGLT-2 medications (Jardiance, Invokana, Farxiga, Brenzavvy, etc.)
Stop 3 days prior to surgery.
Herbal medications and supplements
Stop 7 days prior to surgery.
All other prescription medications
Continue unless directed otherwise. Take approved medications on the morning of surgery with a small sip of water.
Fasting Instructions
Nothing to eat or drink for 8 hours before your arrival time
This includes no gum chewing or hard candy. Follow this rule strictly — eating or drinking before surgery may require postponing your procedure.
Blood thinners: do not stop without contacting your prescribing provider
If you have been prescribed aspirin or blood thinners by a cardiologist or other physician, contact that provider before making any changes. Do not stop on your own. Examples include: Warfarin (Coumadin), Plavix, Lovenox, Xarelto, Eliquis, and over-the-counter aspirin. If your blood thinner cannot be stopped for the required timeframe, contact your surgeon to discuss.
Day of Surgery
Hygiene & Logistics
Hygiene
Shower the night before and the morning of surgery using an antibacterial soap. Do not use lotions, powders, or deodorant on the day of surgery.
What to bring
Photo ID, insurance card, and your complete medication list. Leave all valuables and jewelry at home — your driver will be responsible for belongings while you are in surgery.
Driver required
You must arrange for a responsible adult to drive you home. Public transportation and ride shares (Uber, Lyft, etc.) are not permitted unless accompanied by a responsible adult.
Additional instructions
After surgery you may shower but should not submerge the surgical incision in water. Avoid sitting in a bathtub, pool, or hot tub until cleared by your surgeon.
Surgery time may change
The time of your surgery may change. If your scheduled time changes, the facility will contact you. Please plan to be available for surgery at any time on your scheduled surgery date.
About the Procedure
What Is PCNL?
Percutaneous nephrolithotomy (PCNL) is a treatment for large or irregularly shaped kidney stones, or stones that have not responded to other treatments such as ureteroscopy or shock wave lithotripsy.
What happens during surgery
You will be fully asleep under general anesthesia. You will be positioned on your stomach and the surgeon will access the kidney through your back or flank through a small incision. Once the stone is located, surgical instruments are used to break it into fragments. Larger fragments are removed; smaller pieces pass in the urine. The surgeon may place a ureteral stent to allow stone fragments and urine to flow out of the body.
Recovery
What to Expect After Surgery
Blood in urine
Expected for several days to up to 2 weeks after surgery.
Incision drainage
A small amount of blood or clear fluid from the incision site is normal for a few days to about a week.
Pain and soreness
Some soreness or pain at the incision site is expected. Take pain medications as prescribed.
Stent (if placed)
If a stent was placed, it will remain for several days to weeks. You may feel an urgent need to urinate. Stent removal instructions will be provided at discharge.
After Surgery
When to Call Your Doctor
Contact your care team if you experience any of the following after discharge:
Fever
Temperature over 101°F
Wound concerns
Redness, warmth, swelling, or drainage from the incision or surgical site
Breathing / chest
Shortness of breath or chest pain
After hours
Call (865) 305-9254 and follow prompts for the on-call provider. For emergencies, go to your nearest ER or call 911.
University Urology & UTMC Contacts
Questions About Your PCNL?
Contact our office or message us through Klara. For day-of-surgery questions, call Leah directly at (865) 440-1579.