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Percutaneous Nephrolithotomy Health Feed

Nephrolithiasis - Diagnosis And Treatment!

MBBS Bachelor of Medicine and Bachelor of Surgery, MD - Medicine, DM - Nephrology
Nephrologist, Pune
Nephrolithiasis - Diagnosis And Treatment!

Kidney stones are often small enough and pass through urine without much bother. Most kidney stones are smaller than 4 mm in diameter. Having said this, even the smallest of kidney stones can be really painful until they pass through urine. It typically takes a couple of days for the body to get rid of it. While medication and self-care are the foremost options, there are a range of other options as well available for treating kidney stones.

Admission to a Hospital-

You must get admitted to a hospital if the stone moves to the ureter, thereby resulting in severe pain. Typically kidney stones which are more than 6 mms in diameter need to be surgically removed through procedures such as ureteroscopy, percutaneous nephrolithotomy (PCNL), open surgery and extracorporeal shock wave lithotripsy (ESWL).

A doctor takes a call on any of the above procedure if:

  1. The patient is inching towards a kidney failure.

  2. The pain doesn’t go away even after taking pain killers.

  3. If the patient is pregnant.

  4. If the patient is more than 60 years.

Extracorporeal Shock Wave Lithotripsy (ESWL)-

ESWL is one of the simple and most preferred stone removing procedures. It involves the usage of ultrasound shock waves to break the bigger stones into smaller ones. The latter is then passed through urine. A patient is given a few painkillers since this mode of treatment could be a little uncomfortable. A patient might need multiple ESWLs to successfully get rid of all the stones.

Ureteroscopy:

If a stone gets stuck in the ureter, a medical procedure known as the ureteroscopy is performed. In this procedure, a thin telescope is passed through the urethra and bladder to the ureter. Either a second instrument is used or the telescope itself has laser energy to break the bigger stone into smaller ones. This procedure is ideal for stones that have a diameter more than 15 mm.

Percutaneous Nephrolithotomy (PCNL)

PCNL is an alternative to ESWL for removing big stones. This procedure involves the usage of nephroscope that is routed into the kidney through a small incision made behind the back of the patient. This procedure requires general anesthesia and is effective for breaking stones that have a diameter of 20 mm or more. It has a success rate of 86%.

Open Surgery:

This is one of the older methods to eradicate kidney stones. Unless the stone size is abnormally large and other procedures cannot be performed, open surgery is generally avoided. An open surgery involves making an incision and getting access to the ureter and the kidney. The surgeon then removes the stone from the kidney. This procedure requires general anesthesia and the patient needs to be under observation for at least 24 hours, post surgery.

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

MBBS, MS - General Surgery
General Surgeon, Faridabad
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.

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