Home | Procedures | Percutaneous nephrolithotomy
By Dr J Srikanth
Senior Consultant Urologist
Published on 21 October 2022

Article Context

  1. Overview
  2. Procedure
  3. Benefits and risks
  4. Care at Medicover
  5. Frequently Asked Questions

Overview

Percutaneous nephrolithotomy (PCNL) is a technique used to remove stones from the kidney or ureter that are too large for other stone removal techniques such as shock wave lithotripsy or ureteroscopy. Stones that are larger than 2 cm (the size of a marble) require this procedure.

Kidney stones form in the urinary tract as a result of the crystallization of chemical compounds in urine. It can block the urinary flow and cause the kidney to enlarge and the ureter to spasm, which can be quite painful.

Procedure

Before the Procedure

  • Doctor will schedule an appointment for lab tests such as blood and urine tests and an electrocardiogram (EKG).
  • Inform your doctor about every prescription you have, vitamins and supplements, herbs and natural remedies, and over-the-counter drugs.
  • Inform the surgeon in case you are allergic to medicines and the contrast agent used in some X-rays.
  • Discuss with your doctor about medicines that might increase your risk of bleeding, such as aspirin, ibuprofen, warfarin, clopidogrel and non-steroidal anti-inflammatory drugs. You may have to stop taking some of these medicines before the procedure.
  • You will receive an antibiotic, either by mouth or through an IV, right before the procedure to prevent infection.
  • You should not eat, drink or smoke for 6-8 hours to prepare for anesthesia.
  • The anesthesia team will attach monitoring devices to you. In almost all cases, you will be placed under general anesthesia for this procedure.

During the Procedure

  • After you are asleep, the surgical team places you very carefully into the prone position (on your abdomen).
  • This procedure is performed on patients with kidney stones that are large, very firm, or resistant to other forms of stone treatment.
  • Typically, the surgery lasts three to four hours. A small 1 cm incision is made in the patient's flank area to perform the surgery.
  • A nephroscope, a small telescope, is then passed through the tube to visualize the stone, break it up completely, and remove it from the body. A laser or another device known as a lithotripter may be used to break up the stone before it can be removed if necessary.
  • When compared to open stone surgery, this procedure results in significantly less post-operative pain, a shorter hospital stay, and an earlier return to regular daily activities.

After the Procedure

  • You will be shifted to the recovery room following your surgery and then to your hospital room once you are fully awake. Pain in the flank area overlying the kidney is common in the first few days, but it is well controlled with intravenous or oral pain medication provided to you.
  • A nephrostomy tube drains urine from your kidney directly into a drainage bag. It is commonly used to stop bleeding from the tract between the skin and the kidney. Urine from the kidney is frequently blood-tinged and will clear in the days following surgery. You may be discharged with a nephrostomy tube from the hospital if your surgeon determines it is necessary. The tube will then be removed in the hospital at the bedside 1-2 weeks after surgery.
  • A ureteral stent (DJ stent) is a small flexible plastic internal tube used to promote urine drainage down to the bladder. This will be removed by your surgeon within 1-2 weeks of surgery.
  • A foley catheter in the bladder is placed in the operating room while you are asleep and is left in place for about one day after the surgery. This allows your surgical team to monitor your urine output in real time. It is common to have blood-tinged urine for several days following surgery. Prior to discharge, the catheter will be removed.
  • Over the first two days after surgery, your diet will be gradually transitioned from clear liquids to solid foods as tolerated. In addition, intravenous fluids will be given to keep your body hydrated after surgery. However, most patients will not regain their appetite until they are discharged and at home.
  • Deep breathing exercises are essential for lowering the risk of pulmonary complications such as pneumonia.
  • It is recommended that you walk at least 4-6 times per day while in the hospital to reduce the risk of clots.

Benefits

This technique is more successful than other techniques, such as extracorporeal shock wave lithotripsy (ESWL), at clearing all stones in a single setting.

Risks

Even though this procedure has proven to be safe, there are risks and potential complications, as with any surgical procedure. Potential risks include:

  • Bleeding: This procedure will result in some blood loss, but patients will rarely require a blood transfusion.
  • Infection: To reduce the risk of infection after surgery, all patients are given broad-spectrum antibiotics.
  • Tissue / Organ Injury: Although rare, injury to surrounding tissue/organs such as the bowel, vascular structures, spleen, liver, lung, pancreas, and gallbladder may necessitate additional surgery. Kidney failure is uncommon, but it is a risk. Scar tissue can form in the kidney or ureter, necessitating additional surgery.
  • Conversion to open surgery: If complications arise during this surgical procedure, it may be necessary to convert to a standard open operation. This could lead to standard larger open incisions and a longer recovery period.
  • Failure to remove the complete stone: There is a chance that the stones will not be completely removed, usually due to the size or location of the stone. Additional treatment may be required.

Care at Medicover

Medicover Hospital provides kidney stone treatment with a team of the best urologists, nephrologists, laparoscopic surgeons, paramedics, dietitians, and physiotherapists. We are equipped with state-of-the-art facility, world-class laser technology offering comprehensive treatment for all types of kidney stones and its complications. We have the best team of doctors for kidney stone treatment in India. They are experts in performing percutaneous nephrolithotomy for kidney stone removal. Our latest technology offers the patient faster recovery time and advanced care at affordable cost.

Frequently Asked Questions:

The main advantage of PCNL over other treatments is that it treats and removes large stones in a single session using a minimally invasive approach.

The complications following PCNL are infection, hemorrhage, adjacent organ injury, retained stone and loss of kidney function.

There are a few diets that have been linked to an increased risk of stone formation, and avoiding them will help to some extent. In general, reducing protein and salt will help. Taking plenty of fluid will also help to reduce the frequency of stone formation.

Stone removal can improve renal function by eradicating obstruction and, in certain cases, an underlying infection.

The alternatives procedures to PCNL include lithotripsy, ureterolithotomy and open surgery.

Medical imaging such as CT scan is performed immediately after the surgery to assess clearance of kidney stones. If there are no signs of kidney stones, the procedure is determined as a success.

Most patients resume work 1 to 4 weeks after the procedure. It may take up to 6 weeks to fully recover.

References