PCNL- Percutaneous Nephrolithotomy

For dense/ numerous ureteral/ kidney stones, larger than 2 cm, are treated by ureteroscopy/ extracorporeal shock wave lithotripsy (ESWL). PCNL- Percutaneous Nephrolithotomy offers a high success rate, speedy alternative to open surgery, a minimal (1 cm) invasive method of the stone removal. As compare

Is Percutaneous Nephrolithotomy Safe?

As safe as traditional open surgeries. Minimal blood loos, pain, blood transfusion, only overnight hospital stay.

Length Of Percutaneous Nephrolithotomy:

3- 4 hours.

Diagnosis:

Percutaneous Nephrolithotomy is recommended after the following diagnosis tests.

  • Physical exam
  • Medical history.
  • X-ray.
  • CT scan.
  • MRI scan.
  • Sonogram.
  • KUB.
  • EKG (electrocardiogram)
  • CBC (complete blood count)
  • PT / PTT (blood coagulation profile)
  • Comprehensive Metabolic Panel (blood chemistry profile)
  • Urinalysis

Treatment:

Laparoscopic surgery is used to treat the cancers by organ removals.

  • Partial organ removal.
  • Complete organ removal.
    Eg: Colon, ovaries, bladder, prostate, kidneys.

Preparation:

Certain medications to be specifically avoided pre surgery:

  • Aspirin.
  • Ibuprofen Motrin.
  • Voltaren, Plavix, Lovenox, Vioxx, Celebrex.
  • Advil, Ticlid, Alka Seltzer, Coumadin, Vitamin E.
  • Arthritis medications: avoided since before a week of the surgery otherwise it can cause bleeding during the surgery.
  • The urine culture analysis should be negative.
  • In case of UTI Urinary Tract Infection, it should be treated before the surgery by prescribed antibiotics.
  • In case of severe lung/ heart conditions, it is advisable not to perform PCNL on the patient.

Procedure:

  • PCNL is carried out under general anaesthetic.
  • The patient is kept lying down on the abdomen.
  • The bladder’s telescopic examination known as cystoscopy is performed.
  • A small catheter connecting the ureter to the affected areas of kidney is placed and carbon dioxide/ X-ray dye is inserted through it for better visibility.
  • After locating the stone in such a manner, a small needle is inserted through the skin to reach the stone directly.
  • Dilating this needle tract up to 1 cm, a telescope and a plastic sheath is directly placed to visualize the stone. If required more tracts are prepared for the successful removal of the stones.

Risks:

The PCNL potential risks include:

  • Failure to remove the stone.
  • Need of an open surgery.
  • Bleeding.
  • Fever.
  • Nausea.
  • Constipation.
  • Fatigue.
  • Urinary abnormalities.
  • Drainage from incision.
  • Infection.
  • Lower body aches.
  • Organ/ Tissue Injury
  • Ureteral stent: Internal ureteral stent in is placed between the kidney and bladder for smooth drainage from the kidney.
  • Urinary Catheter to drain the bladder.
  • Nephrostomy Tube.
  • Incentive Spirometry device is used to help patient do necessary respiratory/ coughing/ breathing exercises to avoid infections.
  • Diet.
  • Mobilization/ Ambulation: Important to begin walking a day after surgery, to prevent blood clots.
  • Re-operation in case of complications or incomplete removal of stones.

Follow- up:

It’s usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest there could be a problem, such as:

  • 24 hour surveillance.
  • Visit doctor:
  • Removal of cathedral/ urinary stent/ spirometry device 2 3 weeks after surgery.
  • Emergency Follow up:
  • Chest pain/ breathing difficulty.
  • Vomiting/ nausea
  • Worsening pain .
  • Large amounts of blood clots in the urine.
  • Difficult/ painful voiding and fully emptying the bladder.

All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient. Only a well experienced urologist should perform the above treatment.