Percutaneous Nephrolithotomy (PCNL)

Overview -

A cystoscopy is performed first. A thin, illuminated telescope is passed through your pee canal to view the inside of the urethra and bladder. The stone is then passed by the side of the kidney with a tiny (ureteric) catheter. During the PCNL, this is utilised to inject contrast to visualise the intricacies of the kidney.

Your doctor may choose supine or prone PCNL depending on the stone, renal architecture, and patient characteristics. You'll be laying backwards. with a slight inclination to the other side in supine PCNL, whereas you will be lying on your stomach in prone PCNL. 1 cm incision is made in the back, over the kidney region, in both approaches. A track is formed into the kidney through this little incision in order to reach the stone. X-ray pictures guide the entire procedure. The quantity of stones, their location, and the anatomy of the kidney itself will determine whether there will be one or several incisions.. Once a track has been made, an endoscope is inserted into it and into the kidney to visualise and remove the stone. Different ways are used to break stones. Stones are broken by laser if the track is very small.

After the surgery, a drainage tube is placed through this tract for one or two days.

Why it’s done -

In the following cases, percutaneous nephrolithotomy is usually recommended:

• Large kidney stones obstruct more than one branch of the kidney's collecting system (known as staghorn kidney stones)

• Kidney stones are larger than 0.8 inch (2 centimeters) in diameter

• Large stones are in the ureter

• Other therapies have failed

Several tests will be performed by your doctor before you undergo percutaneous nephrolithotomy. A computerised tomography (CT) scan determines where the stones are in your kidney, and urine and blood tests look for symptoms of infection or other issues.

Surgery Procedure –

This approach has been used for a few years now and is performed on a large number of patients and has become the acknowledged standard of care for patients with kidney stones that are large, particularly firm, or resistant to conventional modalities of stone treatment. As a result, it has largely replaced open kidney stone surgery in the great majority of patients.

In MEDIPULSE hospital the Doctor of our Urology Department concluded the operation normally lasts three to four hours. to perform. A minor 1 cm incision is made in the patient's flank area to execute the procedure. A catheter is inserted into a vein under the skin. x-ray guidance kidney through the incision. The stone is then visualised, broken up, and removed from the body using a small telescope pushed via the tube. Before the stone can be removed, a laser or another equipment known as a lithotripter may be used to break it up. When compared to open stone surgery, this method has resulted in much reduced post-operative pain, A catheter allows for a shorter stay in the hospital and a quicker return to work and daily activities. This approach also has a greater success rate for removing all stones in a single session than other treatments like extracorporeal shock wave lithotripsy (ESWL), which sometimes requires many attempts. beneath the skin, aced into a vein

Risks and Complications -

Although this surgery has proven to be quite safe, there are risks and potential consequences with every surgical procedure. When compared to open surgery, the safety and complication rates are comparable. The following are some of the potential hazards

• Bleeding: This treatment will result in some blood loss, however patients will seldom require a blood transfusion. You must inform your surgeon if you are interested in autologous blood transfusion (donating your own blood). When you receive your surgery information packet, you will also receive an authorization form to fill out and return to the Red Cross. This will need to be coordinated with the Red Cross in your area.

• Infection: To reduce the chances of infection following surgery, all patients are given broad-spectrum antibiotics. After the surgery, if you develop any indications or symptoms of infection (fever, discharge from the incision, urine frequency or discomfort, pain, or anything else that concerns you), please contact us right once..

  Tissue / Organ Injury: Although rare, harm to nearby tissue/organs such as the colon, vascular structures, spleen, liver, lung, pancreas, and gallbladder could necessitate additional surgery. Kidney failure is uncommon, although it is a possibility. Scar tissue might form in the kidney or ureter, necessitating further surgery.

• Conversion to open surgery: If complications arise during this surgical treatment, it may be necessary to convert to a regular open operation. This could result in a lengthier recovery period and a larger conventional open incision.

• Failure to Remove the Stone: There's a chance the stone(s) won't be able to be entirely removed, mainly owing to the size or position of the stone (s). It's possible that you'll need more treatment.

Do’s and Don’ts after PCNL :

Do’s

• For the next four weeks, don't lift anything heavier than ten pounds.

• For the next two weeks, don't drive a car and keep long automobile excursions to a minimum.

• For the next four weeks, no intense exercise is allowed, and stair climbing should be kept to a bare minimum.

• NO squeezing or straining during bowel motions; if necessary, take a laxative.

Don’ts

• Drink plenty of water to keep your pee flowing freely. (This will wash out tiny clots that are still forming as a result of the healing process.)

• Keep a urinal handy. (You may not have much notice that you need to empty your bladder.) For the first few weeks of healing, some dribbling and poor control is to be expected.)

• You may get pain in your kidneys or become quickly exhausted. You may need to conduct less rigorous activities while you heal if this happens.

Insurance Covered – Following insurances are covered for PCNL :

 The average length of stay - entails 1 days in hospital & 5-7 days to fully recover. 

Doctors who perform PCNL procedure :