Percutaneous Nephrolithotomy (PCNL)

What is Percutaneous Nephrolithotomy?

Percutaneous Nephrolithotomy is another form of lithotripsy. This procedure is required when either the stones are too large for other procedures, there were remaining stones after an extracorporeal shock wave lithotripsy, if the kidney stones are damaging the area where they are present or if you were not deemed an appropriate candidate for a lithotripsy that requires a ureteroscope.

How is it Different From a Lithotripsy?

This procedure is going to be performed under general anesthesia. There will be incisions made within the back to enter the kidney. Then, a nephroscope, similar to a ureteroscope, will be inserted through the incisions to grant the Urologist sight within the kidney. This tool possesses a larger tube than the ureteroscope. In this procedure, instead of breaking down the stones into smaller pieces for them to be transported out, the nephroscope removes them through a tube entirely. If the stones were first broken down through a nephrscope, then this is referred to as a Percutaneous Nephrolithotripsy.

The Procedure 

This procedure is a minimally invasive procedure but it does need to be performed in a surgery center. This is not a procedure that can be performed in the office. At the surgery center, you will receive anesthesia and the doctor will ensure you are comfortable. 

Typically, the length of the surgery is three to four hours. The surgery is performed by making a small incision in the patient’s back near the kidneys. A small telescope is then passed through the tube in order to visualize the stone, break it up and remove it from the body. If necessary a laser or other device called a lithotripter may be used to break up the stone before it can be removed. This procedure has resulted in significantly less post-operative pain, a shorter hospital stay, and an earlier return to work and daily activities when compared to open stone surgery. 

What to Expect After a Percutaneous Nephrolithotomy?

The effects of lithotripsy sometimes may be painful. You’re likely to see bleeding in your urine and pains in your lower abdomen. The best way to relieve pain is to drink large amounts of water and use some type of oral pain medication. If problems persist for more than a week such as continued bleeding, severe pain, or a strong feeling of needing to urinate, then contact your healthcare provider immediately. Although seldom, these kidney stones may cause bleeding near the kidney, a blockage within your urinary tract, or possibly severe damage where the stone was residing.

What are the Risks or Complications of PCNL?

All surgeries have risks, even minimally invasive procedures. Some risks of PCNL include:

• Anesthesia risks.
• Healing problems.
• Infection.
• Mass of clotted blood (hematoma).
• Blood clots.
• Fluid buildup at surgical sites (seroma).
• Kidney damage.
• Sepsis or a complicated urinary tract infection.
• Inability to remove the kidney stone.

Contact a medical professional at Z Urology if you have any of the following symptoms,

• Blood in the urine.
• Painful or frequent urination.
• Foul-smelling or cloudy urine.
• Fever (if an infection is present.)