Percutaneous Nephrolithotomy (PCNL) Treatment

Percutaneous nephrolithotomy is a medical procedure to remove kidney stones that do not go away on their own. Usually these stones are large, beyond 2 cm in diameter. This medical surgery is typically recommended by a medical professional when all other options for passing a kidney stone have failed or are not practicable. It normally takes three to four hours to complete this surgery. The surgery is as effective as bladder stone removal treatment. 

Usually kidney stones pass on their own. Size and location of the stone is an important criteria for the kidney stone to pass on its own. Normally, a stone that is less than 5 mm may take a week or two to pass. A big stone can take 2 to 3 weeks to totally go away.

A tiny cut is made in the skin and a narrow tunnel is created directly into the kidney. Through this tunnel special medical instruments are put in. It breaks up the kidney stones, and then removes them through the tunnel. This medical surgery allows for quick patient recovery and a safer operation. 

Who is this Surgery Recommended For?

If a kidney stone is present and is big enough that it won’t pass on its own, then you are in the right candidate for this procedure. Also this stone is too large to treat with shock wave lithotripsy or laser ureteroscopy treatment.

Benefits

• PCNL has a high success rate, frequently approaching 100%, in removing large or complex kidney stones in a single surgery.

a) Suitable for complex stones

• Unlike other stone removal treatments, PCNL may efficiently treat large stones (over 2 cm) and stones in difficult locations within the kidney.

b) Minimally invasive

• PCNL is less invasive than typical open surgery. It requires a smaller incision and typically results in speedier healing and recovery with less postoperative pain.

Risks

Certain risks and potential problems, just like any other surgery are bound to occur that include: 

1. Bleeding

•  Although uncommon, the procedure can cause bleeding during or after the procedure. 

2. Infection

• Following surgery, there is a risk that infection may develop in the kidney or urinary tract. 

3. Damage to the kidney

• During instrument insertion, there is a slight possibility of damaging surrounding organs like the intestines, colon, or blood vessels.

4. Urinary leakage

• Urine leakage may occur around the kidney region for the time being after the surgery.

PCNL Surgery Procedure

This medical surgery has been performed on a considerable number of patients in recent years. It is now considered the standard of care for patients with kidney stones that are large, mainly firm, or resistant to other types of stone treatment. 

1) Before the Surgery

Before the start of medical procedure, your vital signs such as blood test, ultrasound, and X-ray may have to be taken. It can also include:

• What to wear for the medical procedure
• When to use or stop taking certain drugs that may induce bleeding.
• What food should be taken and what is to be avoided.

2) During the Surgery

This procedure will be performed by a specially trained team of healthcare experts. The team usually includes:

• A urologist.
• An anesthesiologist.
• Nurses or support staff.

Most PCNL procedures involve lying on your stomach so that the urologist may approach your kidney through your back. 

Incision

• A small cut is made in the patient’s back to access their kidneys.

Guiding of a hollow tube

• Under x-ray guidance, a catheter is inserted into the kidney through the incision. 

Kidney removal

• A tiny telescope is passed through the tube so that the stone is then visualized, broken up, and removed from the body. In specific cases, the stone can be broken up with a laser or another tool known as a lithotripter. 

Closure

• After the completion of surgery, the incision is closed with stitches or a suitable dressing.

3) After Surgery Care

Following PCNL, the patient is often admitted to the hospital for a day or two of observation. Normally patients recover 2 to 4 weeks after this medical surgery.

Here’s what you may expect:

Observation

• Medical staff closely follow the patient in a recovery room until they awaken from anesthesia and their vital signs are stable. 

Pain Control

• The patient may feel discomfort or pain after the surgery. It can be alleviated with pain medications provided by their physician.

Intake of Fluid

• Drinking enough water is essential for flushing out any residual stone fragments and staying hydrated keeps the body healthy.

Activity limitation

• Intense activities or heavy lifting should be curtailed for a period of time following the treatment to allow for adequate recovery.

With respect to open stone surgery, this treatment leads to a shorter hospital stay. Also considerable reduction in post-operative pain, and an earlier return to work are other positive aspects of this surgery.