Dr Bivek Kumar - Urologist

21/07/2026

PCNL Surgery for Kidney Stones: A Urologist's Simple Guide

When a kidney stone is small, it often passes on its own or with medication. But some stones grow too large, become too hard, or fill the kidney's drainage system so completely that they cannot be treated with sound waves or a laser alone. For these stones, the treatment I most often recommend is PCNL - percutaneous nephrolithotomy.

I'm Dr. Bivek Kumar, a Consultant Urologist and Andrologist, and I perform PCNL regularly for patients across east Bengaluru. In this guide I'll walk you through what PCNL actually involves, in plain language, so that if it's ever suggested for you or a family member, you know exactly what to expect.

What is PCNL?

"Percutaneous" means through the skin, and "nephrolithotomy" means removing a stone from the kidney. So PCNL is keyhole surgery in which I remove a kidney stone through a small opening - usually around one centimetre - made in the skin of your back.

Through that keyhole, a narrow telescope called a nephroscope is passed directly into the kidney. The stone is then broken into fragments and cleared out in the same sitting. Because it works through a tiny tract rather than a large open cut, PCNL has largely replaced the old open stone surgeries for big stones.

When is PCNL the right choice?

PCNL is generally the preferred approach when a stone is large or complex. I usually consider it in situations such as:

• Large stones — generally bigger than 2 cm.
• Staghorn stones that branch through and fill the kidney's collecting system.
• Lower-pole stones larger than about 1.5 cm, which are difficult to clear with sound waves.
• Very hard stones that have not responded to ESWL (shock-wave lithotripsy) or laser.
• Stones sitting behind a narrowing or obstruction in the kidney.

The right treatment always depends on the individual - the size, number, hardness and position of the stone, the anatomy of your kidney, and your overall health. That decision is made together, after reviewing your CT scan.

How the procedure is done, step by step

PCNL is done under general anaesthesia, so you are fully asleep and feel nothing during surgery. A typical procedure takes roughly one to three hours depending on the stone.

1. Access. Using live X-ray (fluoroscopy) or ultrasound for guidance, a fine needle is placed precisely into the part of the kidney holding the stone.
2. Making the tract. The needle track is gently widened to create a channel just wide enough for the nephroscope - this is the ~1 cm keyhole.
3. Viewing the stone. The nephroscope, which carries a camera and a light, is passed through the tract so the stone is seen clearly on a screen.
4. Breaking the stone. An energy probe - ultrasonic, pneumatic or laser - fragments the stone. The pieces are suctioned or lifted out.
5. Checking and closing. I confirm the kidney is clear, and depending on the case leave a small drainage tube (nephrostomy) or a stent, or use a "tubeless" approach.

For smaller stones, I may use a mini-PCNL or ultra-mini-PCNL, which uses an even smaller tract. A narrower tract generally means less bleeding and a quicker recovery, while still clearing the stone effectively.

Getting ready for PCNL

A little preparation makes the surgery safer:

• A urine test to make sure there's no active infection , any infection is treated first.
• Blood tests and a recent CT scan (CT KUB) to map the stone.
• Pausing blood-thinning medication if you take it, only as advised by your doctor.
• Fasting for a few hours before surgery.

Recovery - what the days after look like

Most patients stay in hospital for about two to four days. Any drainage tube or stent is usually removed during this period or shortly after. Some blood in the urine for a few days is normal and settles down.

Most people are back to light daily activities within about a week, and to fuller routines in one to two weeks. I usually advise avoiding heavy lifting and strenuous exercise for a short while, and drinking plenty of water throughout.

Why PCNL is worth considering

• It can clear a large stone in a single sitting, where other methods might need several sessions or still leave fragments behind.
• It is minimally invasive compared with open surgery - keyhole instead of a long incision.
• It leaves only a small scar.

Risks - an honest word

No surgery is without risk, and PCNL is no exception. Possible complications include bleeding (occasionally needing a transfusion), infection, a small chance of injury to structures near the kidney such as the lung lining or bowel, temporary urine leak, or a residual fragment that needs a second, smaller procedure. Serious complications are uncommon, and I discuss your individual risk with you before we proceed.

PCNL, laser (RIRS) or ESWL - how do they compare?

• ESWL (shock-wave lithotripsy) - no incision at all; sound waves break the stone from outside. Best for smaller, softer stones.
• RIRS / laser (flexible ureteroscopy) - a scope passed up through the natural urinary passage, no external cut; suited to moderate-sized stones.
• PCNL - the approach of choice for large, hard or staghorn stones.

There is no single "best" method - only the best method for your particular stone.

After the stone is gone: preventing the next one

Removing the stone treats today's problem. Stopping the next one is just as important. I usually recommend a metabolic evaluation, good daily hydration, and simple, personalised dietary adjustments to lower the chance of recurrence.

Frequently asked questions

Is PCNL painful?
You feel nothing during surgery, as it's done under general anaesthesia. Afterwards, any discomfort around the keyhole site is usually mild and managed with routine pain relief.

How long does PCNL take?
Most procedures take about one to three hours, depending on the size and complexity of the stone.

How big is the scar?
The keyhole is typically around one centimetre, so the mark left behind is small.

How long will I be in hospital?
Usually two to four days, though this varies from person to person.

When can I go back to work?
Many people return to desk-based work within a week or two. Physically demanding work may need a little longer.

Will my stone come back?
Kidney stones can recur. With a metabolic check-up, good hydration and the right dietary changes, the chance of a new stone can be meaningfully reduced.

PCNL or laser - which is better for me?
It depends on your stone. Larger and harder stones usually favour PCNL; moderate stones may be suited to laser (RIRS). We decide together after reviewing your scan.

Written by Dr. Bivek Kumar, MCh (Urology), FRSM - Consultant Urologist & Andrologist, Bengaluru.
Dr Bivek Kumar - Urologist
Have a large or complex kidney stone? You can review your options with me bring your latest CT scan if you have one.
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This article is for general awareness.

17/07/2026

Every July, my OPD fills with UTI cases - and it's no coincidence.
Traffic-delayed commutes mean held-in urine.
Cooler weather means less water.
Dampness helps bacteria thrive.

⌛️My checklist:
✅️2.5–3 L water daily
✅️void every 3–4 hours
✅️change out of wet clothes fast
👍see a doctor before self-medicating.

Full video on the channel soon.
Dr Bivek Kumar - Urologist

16/07/2026

Jai Jagannath!
Wishing you and your family a blessed Rath Yatra filled with good health and new beginnings.
Team Nelivigi Multispeciality & Urology Hospital, Bellandur.

Dr Bivek Kumar - Urologist

13/07/2026

Why a Bladder Tumour in Bengaluru and One in Bihar Are Not the Same Disease

The biology may be identical. The outcome is decided elsewhere.

By Dr. Bivek Kumar, MCh (Urology), FRSM — Consultant Urologist & Andrologist

───

A recent review in the Urologic Clinics of North America made an argument that every urologist quietly knows but rarely says aloud: for non–muscle-invasive bladder cancer (NMIBC), the difference between a patient who does well and one who does not is often not the tumour — it is the system around the tumour. Insurance status, distance from a urologist, delays in investigating blood in the urine, and access to intravesical therapy shape recurrence and progression more than tumour biology does.

That paper was written about the United States. In India, the same logic holds — only sharper, because our fault lines run deeper.

A cancer that punishes delay and rewards follow-up

Bladder cancer is unusual among malignancies. Most patients present with early, non-muscle-invasive disease that is, in principle, highly controllable. But control is not a single operation. It demands a repeating cycle: cystoscopy, transurethral resection, a course of intravesical BCG or chemotherapy, and then years of surveillance. Miss a step and the cancer comes back — sometimes worse.

This is precisely the kind of disease where a fragmented, unequal, cash-driven health system does the most damage. Every touchpoint that requires money, travel, or a return visit becomes a place where a poorer patient falls off the pathway.

The Indian reality: geography as prognosis

Start with the first symptom — painless blood in the urine. In a metro with urologists on every corner, this triggers a cystoscopy within days. In much of rural India, it is first treated as a "urine infection" by whoever is available, sometimes for months, before anyone thinks of cancer. By the time the patient reaches a urologist, an early tumour may have become an invasive one.

Access is not evenly spread. India's specialist urological care is concentrated in cities and in the private sector, while healthcare delivery has long been documented as biased toward urban areas, with rural households bearing a disproportionate share of health costs relative to income. A patient in the Bengaluru IT corridor and a patient in interstitial Karnataka or the Chhotanagpur belt are, on paper, offered the same guidelines — but the road to those guidelines is very different.

The money problem is a survival problem

India still finances a striking share of its healthcare out of the patient's own pocket — historically around 62% of total health expenditure, among the highest proportions in the world, with roughly a third of the population uninsured at any given time. For a disease that bills you repeatedly over years, this is uniquely corrosive.

Ayushman Bharat (AB-PMJAY) has genuinely changed the picture for many. The scheme has covered more than 68 lakh cancer treatments worth around ₹13,000 crore, and enrolled patients are significantly more likely to start treatment within 30 days of diagnosis. Hospital-level data from Karnataka show AB-PMJAY patients incurring effectively zero out-of-pocket cost for major surgeries, versus 100% for the uninsured. When a scheme removes the cash barrier, patients start treatment sooner — the mechanism could not be clearer.

But coverage is not the same as completion. A card that pays for the resection may not smooth the repeated cystoscopies, the BCG instillations, the travel, and the lost daily wages that surveillance demands. Cancer control in bladder disease is a marathon, and financial protection has to last the whole distance.

BCG: when the medicine itself is the bottleneck

Here India collides with a global problem. Intravesical BCG — the single most important drug for high-risk NMIBC — has been in worldwide shortage with rationing since 2019. The consequences are not abstract.

A real-world series from Tata Memorial Centre, Mumbai, using the Moscow strain of BCG, quantified exactly what is at stake. Patients who received adequate BCG had a 24-month recurrence-free survival of about 95%. Those who could not complete adequate BCG — because of shortage, intolerance, or inability to keep returning for instillations — dropped to roughly 65%. Same cancer. A thirty-point gap in outcome, opened up entirely by whether the patient could actually get and finish the treatment.

This is the heart of the argument. The tumour did not decide that gap. Supply chains, drug availability, distance, and the patient's ability to keep coming back decided it.

There is a distinctly Indian dimension here too: much of the world's BCG is manufactured in India, and the Serum Institute has entered agreements to expand global supply. We are, paradoxically, both a major producer and a country where patients still struggle to complete a full course. Bridging that gap — production to instillation — is a solvable problem, not a biological one.

What this means, and what we can do

If outcomes are driven by care delivery rather than tumour biology, then outcomes are changeable. That should be the optimistic reading.

For clinicians and hospitals, a few things move the needle disproportionately:

• Treat visible haematuria as cancer until proven otherwise — and build fast-track cystoscopy pathways so the first symptom does not become a lost year.
• Enrol early and aggressively into AB-PMJAY and state schemes, and design the whole surveillance course — not just the first surgery — around what the patient can realistically sustain.
• Protect and rationalise BCG supply at the institutional level, use evidence-based dose-reduction and alternative strains when shortage bites, and never let a high-risk patient silently drop out of maintenance.
• Reduce the number of return trips where safe — clustering procedures, using telemedicine for follow-up counselling, coordinating with local providers so a patient in a smaller town is not making a 200-kilometre journey for every review.

For patients and families, the message is simpler: blood in the urine is never normal, see a urologist early, ask whether you qualify for a government scheme, and — this matters most — finish the full course of treatment and keep every follow-up appointment, even when you feel well.

The uncomfortable, hopeful conclusion

Two patients, identical tumours, identical grade and stage. One completes surgery, a full BCG course, and every surveillance cystoscopy on schedule. The other, blocked by cost, distance, a drug shortage, or a missed early diagnosis, does not. Their cancers were the same on the day of diagnosis. Their outcomes will not be.

That difference is not written in the tumour's DNA. It is written in our health system — which means we can rewrite it.

───
Dr Bivek Kumar - Urologist
Dr. Bivek Kumar is a Consultant Urologist and Andrologist practising across Bengaluru. This article is for general awareness and does not replace individual medical advice.

13/07/2026

Right ✅️

11/07/2026

🌟 Varicocele: What You Need to Know 🌟

Are you experiencing pain or discomfort in your sc***um or noticing issues with fertility? A varicocele could be the cause.

🩺 What is Varicocele? Varicocele is an enlargement of the veins within the sc***um, often compared to varicose veins in the legs. It can affect s***m production and quality, leading to potential fertility issues.

🔑 Key Symptoms of Varicocele:

Scrotal swelling or a "bag of worms" feeling
Pain or discomfort in the sc***um
Infertility concerns
👨‍⚕️ Why Consult Dr. Bivek Kumar? As an experienced Urologist, Dr. Bivek Kumar specializes in diagnosing and treating varicocele with personalized care. Whether it’s through minimally invasive surgery or other treatments, Dr. Kumar is committed to providing effective solutions to improve your health and well-being.

👉 If you're noticing any symptoms or want to know more, don’t hesitate to book a consultation with Dr. Bivek Kumar today! Your health matters!

🔗 Contact Us for Consultation: 📞 [+91 7337750332]
🏥BP PODDAR HOSPITALS, KOLKATA
BIVEK UROLOGY CENTER
🏥: 59/1, Jelia Para Ln, Babudanga, Salkia, Howrah, West Bengal 711106
📱 : +91 7337750332
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11/07/2026

CARCINOMA OF PROSTATE

Every man's prostate grows with age , but growth isn't always harmless.

Prostate cancer is one of the most common cancers in men, and in its early stages it often causes no symptoms at all. That's exactly why early detection matters.

Watch for a weak or interrupted stream, waking at night to urinate, difficulty starting or emptying, or blood in urine/semen.

These can point to many conditions — but they're worth checking.

If you're 50+ (or 45+ with a family history of prostate cancer), ask about a PSA test. It's a simple blood test that can catch trouble years before symptoms appear.

Dr Bivek Kumar - Urologist Consultant Urologist & Andrologist (MCh, FRSM)
📍 drbivekkumar.com

10/07/2026