Percutaneous Nephrolithotomy surgery: Purpose, Procedure, Benefits and Side Effects

Percutaneous nephrolithotomy surgery involves removing kidney stones from the kidney that are resistant to previous treatments. This procedure is used to remove kidney stones if; they are too big to pass naturally via the urinary tract, cannot be eliminated using extracorporeal shock wave lithotripsy, are too numerous, too thick, or are in the branching form known as staghorns and obstruct the kidneys and urinary tract.

The surgery is done either under spinal or general anesthesia. The surgery is done simply by making a small 1 cm incision in the skin on the back. The stones are removed during nephrolithotomy using a tube. The patient may be needed to stay in the hospital for at least one night prior to the procedure. The condition is evaluated by checking for infections in the blood and urine. To determine the exact location of stones, it may be necessary to do an ultrasound, X-ray, or CT scan. It is advised to avoid eating or drinking anything after dinner the night before the procedure. To remove all the kidney stones, the treatment typically takes 20 to 45 minutes. Before sucking the stones out via the tube, the stones may occasionally need to be broken down. Nephrolithotripsy is the process of breaking down kidney stones before removing them.

For kidney and ureteral stones that are too large, usually larger than 2 centimeters, too numerous, or too dense are preferred to be treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy, whereas patients with big kidney or ureteral stones often greater than 2 cm, several large stones, or stones that have proven resistant to past ESWL or ureteroscopy therapy are treated with percutaneous nephrolithotomy or stone extraction (PCNL) which offers a minimally invasive method of removing these stones.

There are two types of Percutaneous Nephrolithotomy (PCNL) surgeries;

• Bilateral Percutaneous Nephrolithotomy (PCNL)
• Unilateral Percutaneous Nephrolithotomy (PCNL)

Some of the many benefits of Percutaneous Nephrolithotomy Surgery (PCNL) over alternative therapies like ESWL or ureteroscopy are;

• PCNL offers a minimally invasive approach
• Treats and removes large stones in a single setting
• Multiple stones can be removed.

Additionally, this method is more successful in removing all stones in a single session than other methods, such extracorporeal shock wave lithotripsy (ESWL), which sometimes need many efforts.

When a stone in the kidney or upper ureter- the tube that carries urine from the kidney to the bladder, is too big to be treated with other stone-removal methods like shock wave lithotripsy or ureteroscopy, Percutaneous Nephrolithotomy surgery (PCNL) is used to remove it.

Usually, percutaneous nephrolithotomy is advised when;

• Multiple branches of the kidney's collecting system are blocked by large kidney stones, which are known as staghorn kidney stones
• Kidney stones that have a diameter more than 0.8 inches (2 cm)
• In the tube separating a kidney from the bladder, there are large stones (ureter)
• Various treatments have failed.

Despite being uncommon, here are some of many risks and possible consequences associated with percutaneous nephrolithotomy surgery;

• Bleeding
• Infection
• Adjacent tissue and organ injury
• Failure to remove the stone

Medications to avoid before surgery: The surgeon may advise the patient to refrain from using medications that thin the blood, making it more difficult for clots to form, as a precaution. These medicines include aspirin, motrin, ibuprofen, advil, alka seltzer, vitamin e, ticlid, coumadin, lovenox, celebrex, voltaren, vioxx, plavix, antacids, and several arthritic medications.

The following list of medications has to be avoided at least 7-10 days prior to surgery. Many of these medications can alter platelet function or your body’s ability to clot and therefore may contribute to unwanted bleeding during surgery. Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.

No urinary infections before surgery: Prior to PCNL, it's critical that you stay clear of urinary infection. Therefore, please contact your surgeon right away if you think you might have a urinary tract infection which has symptoms of burning while urinating, blood in the urine, frequent and urgent urination, fevers, etc. Please notify your surgeon immediately if any of these symptoms and signs is present so that proper cultures and treatment may be provided.

• A thorough physical check to make sure the patient is healthy and capable of handling the treatment
• To help with decision-making during surgery, the doctor may order a clinical evaluation
• Notify the physician of all medications, vitamins, allergies, pregnancy, and any other pertinent medical information
• Regarding your food and medications, pay close attention to the doctor's recommendations, especially the day before the surgery
• After all paperwork and registration. On the day of surgery, the patient is taken to the operating room where he is made to lie face-down on the operating table
• The patient is administered general or spinal anesthetic, putting them in deep sleep so that they are not aware of the pain during the procedure

• After giving you anesthesia, your surgeon will perform a cystoscopy (telescopic examination of your bladder) and inject carbon dioxide or an x-ray dye into one of your kidneys through a tiny catheter that is inserted up through the ureter or drainage tube of the kidney that is being treated in order to 'map' the branches of the collecting system. This enables your doctor to detect the kidney stone accurately and reach it directly by inserting a tiny needle into the skin while using an x-ray for guidance
• To install a plastic sheath and telescope to clearly see the stone, this needle tract is widened to a diameter of around 1 cm. The stone is broken up into little fragments using a mechanical, laser, or ultrasonic lithotripsy instrument before being removed from the body through the sheath. Sometimes more than one tract may be needed to get access and make an attempt to remove every stone
• At the conclusion of the procedure, a tiny ureteral stent emptying the kidney to the bladder as well as a nephrostomy tube draining the kidney to an external drainage bag may be left. The procedure typically takes 3–4 hours
• Patients who have chronic kidney stone problems and whose kidney stones have proven resistant to standard medical therapy or alternative kidney removal methods are recommended to undergo percutaneous nephrolithotomy surgery

• Nephrostomy Tube: A nephrostomy tube allows urine to be removed from the kidney and placed straight into a drainage bag. In order to stop bleeding from the passage between the skin and the kidney, it is frequently inserted there. Urine from the kidney is frequently tainted with blood and will clear throughout the days that follow surgery. If your surgeon decides it's essential, you can be sent home from the hospital with a nephrostomy tube. Generally 1-2 weeks after surgery, the nephrostomy tube will then be withdrawn in the office at the patient's bedside
• Ureteral Stent: A ureteral stent is a tiny, flexible plastic tube inserted into the ureter to aid kidney outflow into the bladder. This will normally be removed in your surgeon's office 1-2 weeks after surgery
• Nausea: Patients frequently feel brief nausea in the first or second days after a general anesthetic procedure. Chronic nausea can be treated with medication
• Urinary Catheter: A bladder catheter known as a foley is inserted while you are sleeping in the operating room and remains there for around one day following the procedure. Your surgical team can thereafter keep track of your urine production because of this. After surgery, it is usual to see blood-tinged urine for a few days. Prior to discharge, the catheter will be taken out

The average cost of Percutaneous nephrolithotomy surgery costs between Rs. 2,000 and Rs. 4,000 in India.

A lot of variables may affect the cost of surgery. Along with tier-1 or tier-2 cities; hospital or clinic brand names, the fees of the treating consultant, admission fee, type of the surgery, post-surgical complications that are involved, admission room that you opted for, may have an influence on hospital billing expenses.

Expenses for Percutaneous Nephrolithotomy (PCNL) can also vary from individual to individual due to the following reasons:

• Surgeon fee
• Health condition of the patient
• Size and shape of the kidney stone
• Unilateral or bilateral surgery
• Post-procedure complications that are involved
• Type of the hospital
• The room that you opted for
• Admission fee.

According to post-treatment recommendations made by the surgeon, patients should stay in the hospital for a day or two days following surgery. For a period of two to four weeks, the patient may be instructed not to lift, push, or pull large things. Here are few tips on what to do after Percutaneous Nephrolithotomy surgery;

Ease post surgery discomfort: For the first several days after surgery, pain in the flank area under your kidney is typical, but it is easily managed with intravenous or oral pain medicine, which your nurse will give you upon request.

Follow a healthy diet: Over the first two days after surgery, your diet will gradually transition from clear liquids to solid meals as tolerated. Additionally, intravenous fluids will be given to you after surgery to keep your body hydrated. However, the majority of patients won't start to feel like eating again until they are sent home.

Use incentive spirometry: Deep breathing exercises are crucial in lowering the frequency of pulmonary problems like pneumonia. Your nurses and the surgical team will demonstrate how to utilize an incentive spirometer as you carry out these exercises.

Take up physical exercise: To assist prevent blood clots from developing in your legs, it is crucial to get out of bed the night before surgery and start walking under the guidance of your nurse or a family member. Additionally, SCDs (sequential compression devices) will likely be used to stop blood clots from developing in your legs.

Additionally, it is advised to wait a week before going back to work. If a drainage tube is still in place after surgery, it has to be checked to see if any blood clots or thick, black blood seep through the tube or via urine. If such does occur, the patient must tell the doctor.Hospital Stay: The average patient stays in the hospital for between one and two days.

Diet and the foods you consume are essential in preventing the development of kidney new stones. Here are a few dietary suggestions that would be useful if you had percutaneous nephrolithotomy surgery to remove kidney stones;

• Tuna fish
• Dry fruits
• Avocados
• Bananas
• Pistachio nuts
• Plenty of water
• High-fiber foods
• Citrus fruits
• Natural sources of calcium and vitamin D

These are some common yet important tips to assist you manage the care required after kidney stone removal surgery. Nevertheless, dietary restrictions may vary from patient to patient. Therefore, it is advised to receive the recommendations from a doctor who will take the circumstances of the case into account.

Percutaneous Nephrolithotomy surgery is a totally safe, cutting-edge technique to remove kidney stones larger than 15 mm in diameter with a high success rate. With over 90% of patients reporting pain reduction after only one session, PCNL also offers outstanding outcomes for stones larger than 2 cm. Make an appointment with some of the top urologists in India near your area who have a high percentage of PCNL success by getting in touch with us via Pristyn care.

No, percutaneous nephrolithotomy (PCNL) is not painful as it is a minimally invasive treatment for removing renal calculi and is performed under general anesthetic. The implantation of the stent, however, could cause some little discomfort following the treatment when the anesthetic wears off. To manage pain there are several over-the-counter medications that may help you ease the pain and discomfort.

The total recovery takes between two and four weeks. After the surgery, you might need to stay in the hospital for a day or two. After surgery, you might need to wait 2 to 4 weeks before engaging in any significant lifting, pushing, or tugging. After approximately a week, you might be able to go back to work. After surgery, if you still have drainage tubes in your kidney, you must keep an eye out for any bleeding.

Although this surgery has shown to be quite safe, there are still potential consequences and side effects are involved just like with any surgical operation. Side effects that may exist include:

• Bleeding
• Infection
• Damage to surrounding tissues/organs such the ureter, bladder, liver, or colon
• Urinary leak may persist for a few days
• Conversion to open surgery
• Failure to Remove the Stone

If an infection develops following surgery, the patient can have pain when urinating or feel the need to use the bathroom more frequently.

If you have your surgery performed by the knowledgeable and talented specialists at Pristyn Care, you can significantly lower your risk of experiencing these adverse effects.

• Pain Control: Patients are advised to switch to extra-strength Tylenol as soon as possible in order to avoid constipation and oversedation that may arise from using narcotic painkillers for mild pain at the site of the nephrostomy tube.
• Bathing: Showering with a nephrostomy tube in place is OK, but the region has to be patted dry right away afterward. While your nephrostomy tube is in situ, you should refrain from taking hot tub or tub baths.
• Physical activity: Daily walks are suggested to prevent deep vein thrombosis, or blood clots, from developing in your legs. Avoid spending too much time sitting or in bed. It is possible to climb stairs, but you should go gently.
• Daily activities: Following surgery, driving should be avoided for at least one to two weeks, and then only after narcotic painkillers have been withdrawn. Activity can resume after this point as tolerated. After surgery, you can anticipate going back to work as soon as 1-2 weeks later, according to your doctor's instructions.
• Nephrostomy site care: Maintaining your nephrostomy tube is essential for normal kidney repair. Urine should readily flow from the tube into the drainage bag, which should always be kept below the level of your kidney. When you take a shower every day, gently wash the region surrounding the nephrostomy tube insertion site. After showering, pat the skin dry and use a cotton tip applicator to apply hydrogen peroxide to the region immediately surrounding the insertion site. After cleansing the wound, apply a fresh gauze dressing. The blockage of your kidney, severe discomfort, and infection may occur if urine stops draining from your tube.
• Empty urine bag: If a catheter is placed in the kidney, empty the drainage back before it gets full as it may prevent urine drainage off the body.
• Avoid smoking: Stay away from cigarettes and alcohol before full recovery. Check your nephrostomy tube very away to make sure it is not kinked, pulled, or displaced from its appropriate position. Contact your doctor right away if you suffer any change in discomfort, a fever, chills, pus growing around the catheter insertion site, the catheter not emptying, or the catheter leaking around the tube.
• Follow-up for stent removal: Your surgeon will decide when to remove the ureteral stent, which is typically done one to two weeks after surgery. It is normal to have a mild flank fullness and a need to urinate urgently while your stent is in place. As the body becomes used to the indwelling stent, these symptoms frequently get better with time. A little flexible telescope will be inserted into the urethra during the cystoscopy procedure to allow your surgeon to see and hold the stent's terminal end, which is located in your bladder. Usually, this may be completed in under two minutes.

Percutaneous Nephrolithotomy surgery (PCNL) is a minimally invasive procedure that is used to treat and remove kidney stones larger than 2 mm. The procedure is very secure and safe with a high success rate. It can also be recommended for kidney stones that are too large for other forms of stone treatment such as shock wave lithotripsy or ureteroscopy or for kidney stones that are recurring.