Percutaneous nephrolithotomy is a procedure that involves removal of kidney stones from the kidney which are not possible to remove by other measures. This removal technique is adopted if the kidney stones are too large to get expelled by themselves through the urinary tract or is not removed by simple techniques like extracorporeal shock wave lithotripsy or maybe there are too many stones or they are too dense or are in branched form usually known as staghorn that block the kidneys and the urinary tract. The surgery is done simply making a small 1 cm incision in the skin on the back. In nephrolithotomy the stones are removed through a tube. The surgery is done either under spinal or general anesthesia. Before the surgery is carried out, the patient might be required to be in the hospital at least overnight. The condition is diagnosed by testing the blood and urine for any infection. An ultrasound or an X-ray or a CT scan might be required to prove the exact location of the stones. It is recommended not to have anything to eat or drink after the dinner the night previous to the surgery. The procedure usually takes around 20 to 45 minutes to pluck out all the stones from the kidney. Sometimes the stones may require to be broken down before sucking them out through the tube. This break down of the stones in the kidney before removing them is known as nephrolithotripsy.
After entering the operation theatre, the patient is made to lie down on the surgical table face-down. With general or spinal anesthesia the patient is made unconscious so that the pain of surgery is not felt. The procedure of stone removal from kidney with this technique involves cutting an incision in the skin at one side of the lower back. Thereafter, a fiber-optic camera is inserted into the kidney through a scope. After this a percutaneous nephrolithotomy needle is sent to the kidney whose position is confirmed with the help of fluoroscopy. The stones are removed by simply sucking them through the tube called nephroscope that is inserted with the help of a guide wire that is sent through the needle and this guide wire helps take the dilators and working sheath inside the kidney. The stones may be broken down into smaller particles using a mechanical or ultrasonic device. This process of breaking the stones down is known as nephrolithotripsy. At the end of the surgery a drainage catheter is left in the kidney that exits through the skin. The procedure of creating the tract of stone removal is a difficult one and is normally done with the help of a needle and this is known as antegrade technique.
Any person who already suffers from a severe heart or lung disease or has bleeding problems, will not be eligible for percutaneous nephrolithotomy
Any surgical procedure involves some risks or complications along with it. Percutaneous nephrolithotomy also have some risks associated with it like bleeding, infection or injury to nearby organs like ureter, bladder, liver or the bowel. Sometimes even the lungs, renal blood vessels or even death can occur while conducting the procedure. As precautionary measures the surgeon may recommend the patient to avoid taking drugs that make the blood thinner rendering it difficult to form clot. These drugs are aspirin, ibuprofen, vitamin E, antacids or some medication for arthritis. Infection after a surgery may cause the patient to feel a pain while passing urine, or feel like using the washroom more often.
Post treatment guidelines involve staying in the hospital for a day or two after the surgery as recommended by the surgeon. The patient may be asked not to lift, push or pull heavy objects for about 2-4 weeks. It is also recommended to resume work only after a week’s rest. If a drainage tube is left after the surgery it must be observed if any thick dark blood or blood clot leaks from the tube or through urine. If that does happen, the doctor must be informed about it.
It takes about 2 to 4 weeks to recover completely after the surgery.
The price of percutaneous nephrolithotomy ranges from Rs. 2,000 to Rs. 4,000
Yes, the results of the treatment are permanent.
Alternative to the treatment involves using medications that dissolve the stones, or the stones can also be broken down to smaller fragments using extracorporeal shock wave lithotripsy. Also, drinking around 12 glasses of water every day, using lemon juice in your diet, basil juice, apple cider vinegar, pomegranate juice, celery juice, wheatgrass juice, dandelion juice or horsetail juice can help dissolve the stones and facilitate to pass them through the urinary tract.