A common procedure for the removal of larger cystine stones where a small puncture is made through the skin and into the kidney, through which instruments are inserted to visualize, break up, and remove the stone(s).

Percutaneous means "though the skin." In PCN, the surgeon or urologist makes a 1-centimeter incision under local anesthesia in the patient's back, through which an instrument called a nephroscope is passed directly into the kidney and, if necessary, the ureter. Smaller stones may be manually extracted. Large ones may need to be broken up with ultrasonic, electrohydraulic or laser- tipped probes before they can be extracted. A tube may be inserted into the kidney for drainage.

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