nephrolithotomy

DEFINITION of nephrolithotomy

nephrolithotomy is a surgical procedure to remove kidney stones (calculi) through an incision into the kidney or renal pelvis. Nephrolithotomy is the surgical removal of kidney/upper ureteral stones via direct incision, most commonly percutaneous nephrolithotomy (PCNL) where a tract is created through the flank skin to the collecting system under fluoro/ultrasound guidance, dilating to 24-30 Fr for nephroscope access, fragmentation (laser/ultrasonic lithotripsy), and extraction/basketing; reserved for large (>2 cm), staghorn, or complex stones after failed ESWL/ureteroscopy.

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ETYMOLOGY of nephrolithotomy

greek • Nephro-: Greek nephrós (νεφρός) = “kidney.” • Litho-: Greek líthos (λίθος) = “stone.” • -tomy: Greek tomḗ (τομή) = “incision, cutting.” • Literal: “Kidney stone cutting/incision” (coined 19th century).

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DERIVATIONS of nephrolithotomy

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CPT Coding

Primary Codes (50060-50081):[3][6][2][4][1]

Code	Description (Stone Size/Complexity)	RVU/Notes
50060	Nephrolithotomy; complicated/extended pyelolithotomy (open).	Open approach.
50080	Percutaneous nephrolithotomy/pyelolithotomy ≤2 cm (simple).	Includes dilation, lithotripsy, stent/tube.
50081	Percutaneous nephrolithotomy/pyelolithotomy >2 cm/complex (staghorn, branching).	High complexity; mutually exclusive w/50080.

Access/Dilation Add-ons (if separate):

• 50395 - Establish percutaneous nephrostomy tract.
• 50436/50437 - Dilation of existing tract (NCCI edits apply).[5][2]

Modifiers: -22 (increased work), -51 (multiple), -66 (team).[1]

ICD-10-PCS:

• 0TC03ZZ - Resection kidney stone percutaneous.[7]

Diagnoses: N20.0 (kidney/ureter calculus).[8]

Procedure Types

• Open Nephrolithotomy (50060): Flank incision; rare (<1% cases).
• percutaneous Nephrolithotomy (PCNL, 50800/81): Prone/supine; tract via 18G needle → Amplatz dilators → nephroscope; mini-PCNL (14-20 Fr tracts).[2][4]
• Endourologic: Flexible nephroscopy via tract.[4]

Indications: Stones >2 cm, staghorn, ESWL failure, morbid obesity, abnormal anatomy.[2]

Related Terms

• Nephrolithiasis: Kidney stones (presence).
• Pyelolithotomy: Incision into renal pelvis (subset).
• ESWL: Extracorporeal shock wave lithotripsy (non-invasive).
• ureteroscopy (URS): Endoscopic for lower stones.
• Staghorn Calculi: Branching struvite stones (50081).

Complications (5-30%): Bleeding (transfusion 1-5%), infection/sepsis (3%), pleural injury (supracostal), colon perforation; Clavien III+ ~10%.[2]

Outcomes: Stone-free rate 75-95% (complex cases lower); hospital stay 1-3 days.

One-Sentence Summary
Nephrolithotomy (Greek nephro-litho--tomy “kidney-stone-cut”), primarily PCNL (CPT 50080 simple ≤2 cm / 50081 complex >2 cm), surgically extracts large renal calculi (N20.0) via percutaneous flank tract with lithotripsy/stenting for staghorn/ESWL failures.

Med roots Appendix A Prefixes Appendix B Combining Forms Appendix C Suffixes Appendix D Suffix forms