Introduction
Percutaneous nephrolithotomy, or PCNL, is a minimally invasive procedure performed under general anesthesia to remove kidney stones. It is an inpatient procedure. These kidney stones are large and complex. For this PCNL procedure, a small incision is made on the side of the back and underneath the rib cage. The urologist uses this incision to insert scopes directly into the kidney and locate the kidney stone.
An energy device is used to break the kidney stone with a laser or ultrasound. After a PCNL, a temporary device such as a ureteral stent or nephrostomy is required for urinary drainage. The Stent is inside and goes from the kidney to the bladder, and the nephrostomy tube drains urine directly from the kidney to an external bag. It is essential to have an experienced, comprehensive, integrated team for kidney stone care.
What Is Percutaneous Nephrolithotomy (PCNL)?
Kidney stones are formed in the urine, urinary tract because of the crystallization of chemical compounds. With the PCNL technique, stones in the kidney or upper ureter that are too large for other forms of stone treatment, such as shock wave lithotripsy or ureteroscopy, are removed.
How Is Percutaneous Nephrolithotomy Surgery Performed?
Over the last several years, this procedure has been performed on many patients, and it has been accepted as a standard of care for patients with large kidney stones who are very firm or resistant to other forms of stone treatment. In the vast majority of patients, this PCNL surgery has replaced open operations for kidney stones.
The surgery takes about three to four hours and is performed by making a small incision of one centimeter in the patient’s flank area. Through the incision, a tube is placed into the kidney under the guidance of an X-ray. A small telescope is passed through the tube, which will help visualize the stone, break it up, and remove it from the body.
Before the stone is removed, a laser or other device known as a lithotripter can be used to break up the stone. There is significantly less postoperative pain with this procedure, a shorter hospital stay, and an earlier return to work and daily activities when compared to open stone surgery. This technique has a higher success rate for clearing all stones in one setting compared to other methods, such as extracorporeal shock wave lithotripsy (ESWL), which often requires several attempts.
What Happens After PCNL?
Once the surgery is done, the healthcare provider will cover the stitches with bandages. The kidney stone might also be sent to the lab so the technicians can determine its composition. Identifying the kidney stone’s components can help determine its cause and prevent new stones from forming.
The anesthesiologist will stop administering anesthesia to the body. The patient is transferred to the recovery room. The healthcare providers will review patients to wake up more fully and track their overall health. Though PCNL is a minimally invasive surgery, patients might still need pain medication and management techniques.
The patient is asked to stay in the hospital for a day after the surgery so the providers can monitor the recovery and ensure the patient is beginning to heal and is not having issues with pain management. A small amount of blood might be present in a patient's urine for one to two weeks after surgery. This is normal.
What Are the Results of the Surgery?
A follow-up visit is required four to six weeks after the surgery. If there is a nephrostomy tube for draining the kidney, the patient might return sooner. Ultrasound, X-ray, or a CT scan is taken for the patient to check if any stones are left and to ensure urine is draining as usual from the kidney.
What Are the Advantages Of PCNL?
The main advantage of PCNL is that it removes kidney stones that do not pass on their own or are not removable with other treatments. It is also a minimally invasive procedure that heals faster than open surgeries.
What Are the Potential Risks and Complications of the PCNL Technique?
Although this surgery is comparatively safer than other surgical procedures, the PCNL surgery has risks and potential complications.
The potential risks are:
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Bleeding: With this procedure, some blood loss will occur, but the patient rarely requires a blood transfusion. It is essential to inform the surgeon if the patient is interested in autologous blood transfusion. Regarding the surgery, when the packet of information is mailed to the patient, the patient will also receive an authorization form for the patient to take to the Red Cross.
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Infection: To decrease the chances of infection occurring after the survey, all the patients are treated with broad-spectrum antibiotics. It is essential to contact the doctor if there are any signs or symptoms of infection after the surgery, including fever, drainage from the incision, urinary frequency or discomfort, pain, or anything else that the patient may be concerned about.
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Tissue / Organ Injury: Possible injury to the surrounding tissues/ organs includes vascular structures, bowel, liver, lung, spleen, pancreas, and gallbladder, which could require further surgery. The potential risk is loss of kidney function, which is rare. Scar tissue may also form in the kidney or ureter, requiring further surgery.
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Conversion to Open Surgery: If difficulty is encountered during this procedure, then this procedure might require conversion to the standard open operation. This can result in a larger standard open incision and a longer recuperation period.
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Failure to Remove the Stone: Due to the size or location of the stone, it is possible that it will not be removed completely. Therefore, additional treatment may be required.
Conclusion
The doctor recommends PCNL surgery if the individual has large, multiple, or complex stones. The duration of surgery is one to three hours and might require a hospital stay of a day or two. The patient can resume their daily activities in one to two weeks. After the surgery, a follow up is required after four to six weeks.
