Percutaneous Nephrolithotomy (PCNL) - How Does It Remove Kidney Stones?

Percutaneous Nephrolithotomy (PCNL) is an invasive surgical procedure in which a large (more than 2cm), irregularly shaped, or very dense kidney stone/stones are removed through a small incision in the skin, when other non-invasive procedures are not feasible anymore. Stones are extracted, plucked, or vacuumed by using surgical instruments through a small cut in the back. It is performed under general anesthesia and is considered one of the most efficient approaches to stone removal.

Risks:

Generally, there are not many serious complications following the surgery, but since it is an invasive procedure, there are still chances for them:

1. The procedure might be converted into an open surgery if it is not possible to create a large enough tract for insertion of a nephroscope.

2. The procedure might be converted into percutaneous lithotripsy in which the large stones need to be broken for removal.

3. Infections may lead to fever, pain in incision, and the urge to pee at shorter intervals.

4. Bleeding might occur in case of injury to blood vessels during the procedure.

5. Tissue or organ injury to surrounding viscera might occur in very rare cases.

6. Failed or incomplete procedure of stone removal due to which a repeat procedure might be needed.

Pre-Operative Guidelines:

1. A consolidated physical examination to ensure that the patient is in good shape and can tolerate the procedure.

2. Clinical examination as prescribed by the doctor to make informed decisions during the surgery.

3. Inform the doctor of all medicines, vitamins, allergies, pregnancy, and any other important information regarding health.

4. Follow the instructions of the doctor regarding diet and medications, especially for 24 hours prior to the procedure.

The Operation:

Typically, the following procedure is followed in Percutaneous Nephrolithotomy, but it is subjected to change as per the health of the patient specifically.

1. Using a telescope through the bladder, a small tube is inserted into the ureter.

2. The patient is turned down on the stomach to make a small incision into the kidney.

3. A telescope is then passed into the kidney to locate and remove the stone by breaking it using an ultrasound or laser.

4. The ureteral stent and catheter are removed the next day generally but might have to be left for longer in some cases.

Post-Operative Care:

1. Take all medications promptly, as prescribed by the doctor.

2. Increase water and fluid intake for a speedy recovery and to prevent recurrence of the condition.

3. Incision sites should be protected from water.

4. 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.

5. Simple breathing exercises help to keep the infection away after surgery.

6. Avoid smoking and alcohol before full recovery.

7. Approximately eight to twelve hours after the surgery, it is important to begin assisted walking to prevent blood clots from forming in the legs.

8. Complete recovery takes about six weeks.

Common Side Effects:

1. Occasional vomiting and nausea which, if too intense, should be informed to the doctor.

2. Pain in the abdomen, kidneys, lower back, and sides from 24 to 48 hours post-surgery, which might intensify when urinating. Prescribed medicines can be taken.

3. Blood in urine which should be reported if it is too much.

4. Fatigue, which will subside usually after a month.

However, these side effects are temporary and can be cured by following the post instructions and medicines. It is also recommended to consult a doctor as soon as a patient experiences or notices any changes. One should always follow the post and pre-operative instructions to prevent these side effects.

This method of removing kidney stone is very popular and effective. However, consulting an experienced and skilled surgeon is always advisable. This will help the patient to know all the consequences and results of the surgery.