Stone Procedures - PCNL
Introduction
Kidney stone is a common condition many people experience. To remove kidney stones, surgeons opt for PCNL or Percutaneous Nephrolithotomy. This is a stone procedure used to remove existing stones from a patient’s body when the patient is unable to pass urine.
In this procedure, a scope is inserted through a small incision made on the patient’s back to remove the kidney stones. Percutaneous nephrolithotomy is used for larger stones, especially when other procedures like ureteroscopy or extracorporeal shock wave lithotripsy have failed.
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The PCNL treatment is highly recommended in the following situations:
- Kidney stones are larger than 2 cm or 0.8 inches in diameter.
- Larger kidney stones block more than one branch of the kidney’s collecting system, also called staghorn kidney stones.
- Kidney stones occur in the ureter.
- ● Other treatments have failed.
Before percutaneous nephrolithotomy, doctors ask patients to undergo several tests, including blood tests, ultrasound, CT scan, and urine tests, to check if there are any signs of infection.
The PCNL procedure is usually performed in hospitals where patients are administered general anesthesia, meaning they will not feel pain during the procedure. After the operation, doctors prescribe antibiotics that reduce the chances of infection developing soon after the procedure.
Before the PCNL procedure, the surgeon asks the patient to visit a radiology department to get an x-ray, ultrasound, and CT scan. Once this is done, the patient is transferred to the operating room. Under general anesthesia, the surgeon prefers to check the kidney in the operating room. For this, the surgeon will insert a tube through the bladder to check the kidney and use X-ray imaging to puncture an area of your kidney to remove the stones. If the stones are very large, the surgeon may need to make one more incision or puncture the right part inside the patient’s body.
After the procedure, patients may be required to stay for a couple of days (1 to 2 days) in the hospital. Often, patients are discharged within one day of the procedure. However, due to weakness and other issues, a few patients may be required to stay a day more. Doctors instruct patients about the dos and don’ts post-surgery. This may include avoiding pulling or pushing activities, heavy lifting, etc., for at least 2 to 4 weeks. Patients can usually return to work within 8 days.
If the doctor has inserted a drainage tube in the kidney, the patient needs to check for bleeding. If the patient notices thick blood or blood clots in a drainage tube or urine, he or she needs to visit the emergency department. Also, if the patient develops chills or fever, he or she needs to contact the doctor immediately. These may be symptoms and signs of infection. The doctor will probably order a blood test, urine test, and X-rays before admitting the patient. Also, if there is persistent pain after the procedure, patients must contact their doctors immediately.
Here are a few risk factors of PCNL:
- Organ or tissue injury: Although it is quite uncommon, there might be possible injuries around the organs or kidneys, including the vascular structure, bowel, liver, spleen, lung, gallbladder, and pancreas. In such cases, further surgery might be required. Also, the loss of kidney function is quite rare. However, it is another potential risk. Scar tissue might develop in the ureter or kidney, necessitating another surgery.
- Bleeding: Often, blood loss occurs in this procedure. In such cases, patients may need a blood transfusion. If patients want an autologous blood transfusion, they must inform their surgeons accordingly.
- Conversion to an open surgery: This surgical process might require converting to a standard open surgery if the surgeon encounters difficulty during the process. This means an open incision in the patient’s stomach. In such cases, a longer recuperation time might be needed.
- Infection: Patients are given antibiotics to decrease the chances of infection occurring soon after the surgery. However, if you develop the signs and symptoms of an infection, such as urinary frequency, fever, drainage from the incision, urinary discomfort, pain, or any other issues, contact your doctor immediately.
After the procedure, patients need to visit the doctor in 4-6 weeks. The doctor might suggest an ultrasound test again to check if any traces of the stones are left. Doctors might also suggest measures that patients should take to prevent the recurrence of kidney stones in the future.
Connect with Smiles Institute of Gastroenterology LLP for the best gastroenterology-related treatment.
These are the risks associated with Kidney cancer surgery:
- Reaction with anaesthesia
- Too much bleeding
- Infection
- Incisional hernia
- Leakage of urine into the stomach
- Kidney failure
- Leakage of air in the chest cavity (pneumothorax)
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FAQ's
There might be a risk of incomplete stone removal, depending on the patient’s condition.
This treatment does not prevent a recurrence. However, with proper measures and care, kidney stones may not form and occur in the future.
PCNL procedure is performed using a miniaturized nephroscope.