Percutaneous Nephrolithotomy (PCNL) in Questions

  1. Why do I need this procedure?
  2. What are the benefits of this procedure?
  3. How is it done?
  4. Is the kidney damaged by this?
  5. What are the possible complications?
  6. How successful is it?
  7. How long does it take?
  8. How long will I be in hospital?
  9. Are there any alternatives to surgery?
  10. Is there any thing I need to do before or after the operation?
  11. After the operation
  12. Are there any things I shouldn't do?
  13. What can I expect afterwards?
  14. Where can I get more information?
  15. Why do I need this procedure?

This procedure is done to remove large kidney stones with a keyhole approach

Not all kidney stones need treatment

Stones causing obstruction, pain or that have the potential to grow and damage the kidney should be operated upon.

What are the benefits of this procedure?

With PCNL large stones can be removed in a single operation in most cases.

Most patients recover and return to activity quickly.

How is it done?

After a general anaesthetic is given a tube is placed inside the kidney by looking in the bladder with a telescope

This tube is used to fill the kidney with a special dye seen on Xray. This provides a clear "road map" picture to do the kidney puncture.

You are then placed on your abdomen and the kidney is located with Xray. A needle puncture is made into the kidney and a wire inserted through this.

The wire is used as a guide to allow a tract to be dilated to about 1cm across

A cut of 1.5cm is needed on the skin for this

Once inside the kidney a telescope (nephroscope) is inserted and the stone visualised

The stone is broken up into fragments as required

The fragments are removed

A tube is left in the kidney to allow easy drainage of urine.

Is the kidney damaged by this?

As this is invasive surgery some damage is inevitable.

When the kidney has healed a tiny scar of a millimeter or so across can be seen where the puncture was made.

Tears can also occur to the lining of the kidney. These will heal after the operation with the nephrostomy tube in place.

In the long term these are insignificant changes.

What are the possible complications?

Specific complications and their frequency are listed below. This does not include every possible complication but covers the more common or serious. Complications may also arise from anaesthesia and should be discussed with your anaesthetist. Generally speaking the risks of PCNL increase with the size of the stone, as operating times increase.

Breaking up a large stone into removable fragments also increases the chance of some damage occurring to the kidney.

Bleeding - some bleeding is normal. Heavy bleeding is uncommon (1%)

Early bleeding is treated during the operation. If very severe a conversion to open surgery may be needed to stop the bleeding if all other measures fail. This is very very rare.

Late bleeding - (0.5 - 2%) This occurs if a communication develops between an artery and vein near the puncture site. It is treated with occlusion of the connection via a catheter through the groin or by putting coil in that connection.

Infection

Infection of the urine is not uncommon before the operation. Some stones have bacteria trapped inside them which are released during the operation.

Antibiotics are given routinely. This reduces the risk of infection. Severe infection occurs in around 0.25%.

Rare complications

Bowel injury - an abnormally positioned bowel can be damaged during needle puncture. About 2% of people have this anomaly, but bowel injury is much less common Absorption of large fluid volumes

How successful is it?

PCNL is the most effective means of treating large stones or stones in the lower pole of the kidney

A successful PCNL removes all the stone.

The success of the operation is related to the stone size and stone position. Lower pole stones - 95%

Staghorn stones - 90%

Other techniques may be preferable for different stone types and positions. Choice include ESWL and Ureteroscopic laser stone ablation. Two or three combined techniques are required for treatment of large stones ( Staghorn stones). This is called sandwich technique.

How long does it take?

60 - 90 minutes. This does not include the time for the anaesthetist to put you to sleep or for you to wake up. Typically you are away from the ward for 2-3 hours.

How long will I be in hospital?

Hospital stay is generally 2 - 3 days

Are there any alternatives to surgery?

This should be discussed with your urologist prior to operation. About 5% of stones are dissolvable without surgery

Not all stones need to be removed. Please discuss this with your urologist.

Is there any thing I need to do before or after the operation?

Before coming into hospital:

Stop smoking - seven days smoke free reduces the risks of pneumonia and clots in the legs

Get some gentle exercise - the fitter you are the faster you will recover

Eat lots of fruit and vegetables - to improve your resistance to infections and to heal faster. Also stops you getting constipated.

After the operation

Drink plenty - this will make it easier and more comfortable to pass water

Avoid constipation - straining to open your bowels will increase the risk of bleeding Get out of bed - lying in bed causes pneumonia and clots in the legs

Are there any things I shouldn't do?

No heavy lifting / straining for four weeks

Don't drive until you can comfortably do everything yourself around the house.

What can I expect afterwards?

You will have a nephrostomy tube in place which will probably be removed the next morning. Blood in the urine for up to two weeks is normal (slight reddish urine).

You will feel sore over the kidney. This improves quickly but doesn't go completely for several weeks.

An appointment is made to see you after the operation.

Submitted By:
DR. WAHEED ZAMAN

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Comments

After the success of surgery of kidney stone of a girl,what do it causes if a girl marry and give a birth to a baby?Can she keeps on the sexual relation with her husband?please reply it.I will be great full to u.

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