Percutaneous renal surgery involves the development of a track from the skin directly into the kidney.

Only a small puncture site is needed for percutaneous endoscopic surgery, and with the advent of prophylactic antibiotics there are few complications.

Ideal candidates for percutaneous surgery are those with kidney disorders. The most common indication for percutaneous surgery is to remove large kidney stones (> 2.5 cm), which cannot be effectively treated with extracorporeal shockwave lithotripsy (SWL) or in patients in whom SWL has failed. Any form of anatomical obstruction of the kidney associated with a kidney stone is also best treated primarily with percutaneous surgery.

A thorough history should be obtained and a physical examination should be performed prior to any procedure. Special attention should be paid to the following historical factors: anticoagulation, bleeding disorders, contrast medium reactions, malignancy, obesity, spinal cord injury, and history of urinary tract infections. Essential laboratory data include a coagulation profile, complete blood cell count, electrolytes, blood urea nitrogen, creatinine, platelet count, urinalysis, and urine culture. Appropriate antibiotic coverage before and on call during the procedure is useful in preventing intraoperative sepsis.

Simple percutaneous renal access procedures are performed with the patient in the prone position while under a combination of local anesthetic and intravenous sedation. Percutaneous renal surgery involves the development of a track (usually 1 cm in width) from the skin directly into the kidney. The endourologist then looks directly into the kidney through this track and is able to treat certain kidney disorders.

Patients typically remain in the hospital for a day or two after percutaneous surgery and are able to return to their regular activities in a week or two instead of the one to two months recuperative period required for open surgery.

Postoperatively, patients should be monitored for bleeding, especially in the recovery room. A chest x-ray should be part of the routine postoperative management due to the risk of a pleural tear or perforation when supracostal percutaneous access is obtained. If a pneumothorax or hydrothorax is present, pleurocentesis or placement of a small-diameter thoracostomy tube may be required. Prophylactic antibiotics routinely are continued postoperatively until all tubes are removed and all puncture sites are healed.

The kidneys are bean-shaped excretory organs in vertebrates. Part of the urinary system, the kidneys filter wastes (such as urea) from the blood and excrete them, along with water, as urine.

Percutaneous surgery is based on needle and guidewire access to the kidney and the upper urinary tract. Once guidewire access is obtained, various catheters can then be placed into the kidney, either for drainage or to facilitate antegrade intrarenal or ureteral endoscopic procedures. The tract must first be established and should provide a straightforward route to the kidney, allowing bloodless instrumentation. If more than renal drainage is desired, endoscopic surgery can then continue as a single or staged procedure. With recent advances, many invasive open urologic procedures now are performed endoscopically through small-diameter percutaneous access tracts.

The major advantage of endoscopic surgery is that by using small or no incisions to treat a urologic disorder, the convalescence period from surgery is reduced and the patient is able to resume regular activities sooner than if open surgery was performed.