Percutaneous nephrolithotomy (PNL) is the procedure of choice for the treatment of large or complex” renal calculi” commonly known as “renal stones”. This technique is well established, with high rates of success and accepted morbidity. Percutaneous nephrolithotomy technique is in constant evolution. Supine position has been proved as an acceptable option.
In this surgical procedure the kidney stones are removed from the kidney by a small puncture wound (up to about 1 cm) through the skin using a tube. The kidney puncture for gaining access to the collecting system is usually performed with the help of a fluoroscope. This procedure is usually done under general anaesthesia or spinal anaesthesia. There are few risks with this procedure such as patient may have injuries to the colon, renal blood vessels, infection, sepsis, urinary leak persisting for few days following the procedure, bleeding and in rare cases death. Hence it is recommended that urologists must continue to improve their skills and develop new technologies to offer to the patients a safe and effective option to treat large renal stones. Immediately after the surgery patient is taken to the recovery room, then transferred to the hospital room once patient is fully awake and vital signs are stable.
Post-operative pain: is controlled with pain medication. It is usually via an intravenous saline or by injection shot.
Nephrostomy Tube remains for 1-2 days to drain urine. In majority of cases it is removed before the discharge from the hospital, If required, the surgeon may maintain the same for few more days as felt necessary.
The stents are inserted within the ureter to the bladder to promote drainage from the kidney. This is removed after 1-2 weeks following surgery.
PCNL offers effective option for removal of large and complex stones in patients with minimal invasion. Percutaneous nephrolithotomy are safe with very low morbidity.
Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery. Potential risks include bleeding, infection, injuries to the tissues and organ, failure of the procedure leading to an open surgery and failure to remove stone. It is mandatory that the patient provides all the details of the medical history, details of prescription an non-prescription medicines consumed, details of diet, exercise regime etc. to the surgeon. This helps to evaluate the best option of the intervention. The advisory given by the doctor before and after the surgery must be followed for a successful recovery.
Does a patient need a follow up treatment following PCNL?
Yes; the follow up treatment is targeted to prevent recurrence of the kidney stones.
How long one has to stay in the hospital following PCNL?
The usual hospital stay following successful l PCNL is around 3-4 days. However, the treating doctors shall determine the health status of the patient and shall advice accordingly.
What are the symptoms for which PCNL is recommended?
Patients are recommended PCNL when the urine low is blocked, pain due to presence of kidney stones, large size kidney stone unable to pass through urine, urine leakage, recurrent urinary tract infection due to kidney stones etc.
How long the stent shall remain following the surgery?
The length of time the stent remains in place is variable. Your doctor will probably request it to be removed within a 1-4 week period. This can be removed in the doctor's office. It is common to feel a slight amount of flank fullness and urgency to void as a result of the stent. These symptoms often improve over time as the body adjusts to the indwelling stent. It is critical that patients return to have their stent removed as instructed by their physician as a prolonged indwelling ureteral stent can result in encrustation by stone debris, infection, and obstruction of the kidney.
What are the Do’s and Don’ts once I am back home?
At home you take bath using a shower. The wound site will get wet. It must be gently padded to remain dry. Tub baths are not recommended and are prohibited for at least 2 weeks following the surgery. Daily light walks are advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs should be avoided for at least two weeks and if necessary it should be very slow. Driving for first two weeks following the surgery must be avoided. One can return back to work after 1-2 weeks as advised by the surgeon or the physician.
Lithotripsy is a procedure that uses shock waves to break up stones in the kidney, bladder, or ureter (tube that carries urine from kidneys to the bladder.