What Is Percutaneous Nephrolithotomy?

One of the surgical options for kidney stone removal is percutaneous nephrolithotomy (PCNL). This is a minimally invasive procedure that involves making a small incision in your back or side and inserting a thin tube called a nephroscope into your kidney. The nephroscope has a camera and a light that allows the surgeon to see and break up the stone using special instruments. The broken pieces of the stone are then removed through the tube.

PCNL is usually recommended when other methods of kidney stone removal are not possible or effective. These methods include shock wave lithotripsy, which uses sound waves to break up the stone, and laser ureteroscopy, which uses a laser to vaporise the stone.

PCNL is typically performed under general anaesthesia, which means you will be asleep and not feel any pain during the procedure. The procedure takes about three to four hours to complete. You must stay in the hospital for a few days after the procedure to recover and prevent complications.

PCNL is typically recommended when:

• You have large kidney stones that block more than one branch of the kidney’s collecting system. These are known as staghorn kidney stones.
• You have kidney stones larger than 3 centimetres in diameter.
• You have large stones in the tube connecting a kidney and the bladder (ureter).
• Other therapies, such as shock wave lithotripsy or laser ureteroscopy, have failed or are not possible.

PCNL has a high success rate of approximately 75% to 98%, depending on the stones’ size, location, and composition.

Benefits Of Percutaneous Nephrolithotomy

The benefits of PCNL include:

1. Effective Stone Removal: PCNL is highly effective in removing large and complex kidney stones that may be difficult to heal using other methods. The procedure allows for the extraction of stones of varying sizes and compositions.
2. Minimally Invasive: Compared to traditional open surgery, PCNL is a minimally invasive technique. It involves making a small incision in the skin to access the kidney, reducing trauma to surrounding tissues and organs.
3. Faster Recovery: Due to its minimally invasive nature, PCNL often results in a quicker recovery than open surgery. Patients typically experience less pain and can resume normal activities sooner.
4. Reduced Hospital Stay: PCNL generally requires a shorter hospital stay compared to open surgery. Many patients can be discharged within a day or a few days after the procedure.
5. Lower Complication Rates: While no surgical procedure is without risks, PCNL is associated with relatively low complication rates when performed by skilled and experienced surgeons. Common complications include bleeding, infection, and injury to surrounding structures, but these are infrequent.
6. Preservation of Kidney Function: PCNL aims to preserve kidney function by removing stones that may obstruct the flow of urine & cause damage to the kidney over time. Maintaining kidney function is particularly important when treating large or multiple stones.
7. High Success Rates: PCNL has high success rates in achieving complete stone clearance. The procedure effectively breaks down and removes stones, even those resistant to other treatment modalities.
8. Versatility: PCNL can treat various kidney stones, including those in different parts of the kidney, such as the renal pelvis or calyces. It is also suitable for complex and staghorn stones.
9. Improved Quality of Life: By successfully removing kidney stones, PCNL can alleviate symptoms such as pain, discomfort, and urinary tract infections, contributing to an improved quality of life for patients.
10. Advanced Imaging Guidance: PCNL is often performed with advanced imaging techniques, such as fluoroscopy or ultrasound, which allows for precise targeting of stones & restricts the risk of damage to nearby structures.

Before the Procedure:

1. Medical Evaluation:

• Your physician will conduct a complete medical evaluation, including a review of your medical history and any relevant imaging studies.

2. Preoperative Instructions:

• You may be given specific instructions about fasting before the procedure.
• Inform your healthcare team about any medications you are taking, as some may need to be adjusted or temporarily stopped.

3. Imaging Studies:

• Imaging studies, such as CT scans, may be done to locate the kidney stone and plan the procedure precisely.

During the Procedure:

1. Anesthesia:

• PCNL is typically performed under general anaesthesia, which means you will be unconscious during the procedure.

2. Access Point Creation:

• A small incision or puncture is made in the skin, usually on the patient’s back. This is the entry point for instruments to reach the kidney.

3. Guidewire Placement:

• A thin, flexible wire is guided through the incision and into the kidney, helping to guide the instruments.

4. Dilation:

• The access tract is gradually dilated to create a pathway for the nephroscope, a tube-like instrument that visualises kidney stones.

5. Stone Removal:

• The nephroscope is used to locate and remove kidney stones. Larger stones may be broken into smaller fragments before removal.

6. Placement of Drain:

• A drain may be placed to help remove any residual fragments and fluids.

After the Procedure:

1. Recovery Room:

• After the procedure, you will be taken to the recovery room, where medical staff will evaluate your vital signs as you wake up from anaesthesia.

2. Hospital Stay:

• The duration of your hospital stay is based on factors such as the size and complexity of the stones.

3. Pain Management:

• You may experience some discomfort or pain, and pain medications will be provided as needed.

4. Fluid Intake:

• You will be encouraged to drink a good amount of water to help flush out any residual stone fragments.

5. Follow-up Imaging:

• Follow-up imaging studies, such as X-rays or CT scans, may be performed to ensure all stones have been successfully removed.

6. Recovery at Home:

• Once discharged, you’ll be given specific instructions for at-home care, including activity restrictions and medication guidelines.

7. Follow-up Appointments:

• Follow-up appointments with your urologist will be scheduled to monitor your recovery & address any concerns.

Percutaneous Nephrolithotomy Recovery Time

PCNL usually takes three to four hours to complete. You will be given general anaesthesia, meaning you will be asleep and won’t feel any pain. After the surgery, you will be moved to a recovery room where you will be monitored for any symptoms of bleeding, infection, or other complications. You may have a catheter (a flexible tube) in your bladder to drain urine & a nephrostomy tube (a small tube) in your kidney to drain any remaining stone fragments or blood.

You may feel some pain or discomfort in your back or side where the incision was made. You may also have some blood in your urine. These are normal after PCNL. Your healthcare provider will give you painkillers and antibiotics to help you manage these symptoms. You will stay in the hospital for one to two nights after PCNL. During this time, your medical provider will check your urine output, blood pressure, temperature, and wound healing.

Percutaneous Nephrolithotomy Side Effects

While PCNL is generally considered safe and effective, like any medical procedure, it carries some potential risks and complications. It’s important to note that the likelihood of these complications varies depending on the patient’s health, the size and location of the stones, and the surgeon’s experience. Here are some potential risks & complications associated with PCNL:

1. Bleeding: Bleeding is a common risk during and after PCNL. The procedure involves making a tract through the kidney to reach the stone, which can cause blood vessel injury. Excessive bleeding may need blood transfusions or additional interventions.
2. Infection: As with any invasive procedure, there is a risk of infection. This can occur in the kidney or the surrounding tissues. Precautions, such as prophylactic antibiotics, are usually taken to minimise this risk.
3. Pneumothorax or Pleural Injury: The access to the kidney in PCNL involves passing instruments through the back and into the kidney. There is a risk of unintentional injury to the pleura (the lining of the lung), leading to pneumothorax (air in the chest cavity).
4. Organ Injury: While rare, injury to nearby organs such as the bowel, spleen, or liver can occur during the procedure.
5. Stone Migration: Fragments of the kidney stone may migrate into the urinary tract, leading to obstruction or causing problems in other parts of the urinary system.
6. Postoperative Pain: Pain is common after PCNL. While measures are taken to manage pain, including pain medications, some patients may experience discomfort.
7. Residual Stones: Despite successfully removing the targeted stones, small fragments may be left behind, requiring additional treatments.
8. Renal Function Impairment: In some cases, the procedure can cause a temporary decrease in kidney function. This is usually reversible, but close monitoring is necessary.
9. Allergic Reactions: Some patients may experience allergic reactions to anaesthesia, medications, or materials used during the procedure.
10. Cardiovascular Events: In rare cases, patients may face cardiovascular events like heart attack or stroke, particularly if they have pre-existing cardiovascular conditions.

Why Choose Genesis Superspeciality Hospital for Percutaneous Nephrolithotomy?

Genesis Superspeciality Hospital always prioritizes patient safety, comfort, and satisfaction throughout the treatment process. Dr. Raju R possesses a remarkable history of achieving successful results and holds substantial expertise in Percutaneous Nephrolithotomy?. With exceptional surgical outcomes and competitive pricing, our facility offers prompt surgical scheduling, minimizing patient wait times.