Kidney stones can be removed by a procedure called as a Nephrolithotomy. Percutaneous extraction of renal stone – properly termed percutaneous nephrolithotomy (PCNL) is done via a percutaneous needle-punctured tract of the skin, rather than by an “open” approach wherein inner organs or tissue are exposed (typically by a scalpel). It has evolved and refined with the development of purposely designed instruments, endoscopes and accessories, and has remained a standard treatment for different varieties of renal stones since the eighties.
When is nephrolithotomy procedure indicated ?
Percutaneous nephrolithotomy (PCNL) can practically be applied to most, if not all, renal stones. It is the preferred treatment for obstructive stones that have long been impacted or stones that are deemed too big (greater than 1.5 cm) to be optimal for extracorporeal shock wave lithotripsy (ESWL), because percutaneous removal has less infective and obstructive complications and more effective stone clearance.
How is the nephrolithotomy procedure done ?
This is a major but closed operation requiring admission to the hospital. This approach is best for large stones measuring more than 2 cm. It is a procedure done under general anesthesia as patients need to lie in an uncomfortable position for a relatively long duration, often up to three hours. However, if the operation is done as a staged procedure, percutaneous puncture without track dilatation or removal of simple renal stones could be done under very easily. Accurate percutaneous puncture requires careful positioning of patient. This ensures exact puncture of the collecting system, whilst also protecting the anaesthetized patient from unintentional injury at the same time.
The first step in this procedure is pre-operative urographic assessment with computed tomography. This is helpful in planning the operation. A minute tube is placed directly within the kidney to guide removal of large stones. The second step is to dilate a track from the skin through the kidney into the collecting system, and to place a working sheath. The easiest way to dilate the track is by using a balloon dilator.
The third step is to introduce a nephroscope via the sheath into the renal system to locate the stones. Smaller stones can be easily removed with rigid stone forceps directly via the sheath. Commonly chosen instruments are tripod graspers or forceps with strong alligator jaws. Larger stones will have to be fragmented first using either ultrasonic lithotripsy or laser lithotripsy.
A wound drain and catheter will be inserted to help in drainage of urine. The duration of hospital stay is roughly 10 days.
What are the outcomes of nephrolithotomy procedure ?
Possible Complications are post-surgical sepsis, surgical hemorrhage, urinary fistula, recurrent stones, injury to neighboring bowel, failed access, and in supracostal punctures, either pneumothorax and pleural effusion. You may pass blood in your urine initially (the color of your urine will be pink-red). This should clear in 2-3 days. You may also feel a burning sensation when you pass urine for the initial 1-2 days. You may have to take analgesics for relief. If needed, you can take stronger painkillers. Drink plenty of fluids (around 6-8 oz glasses). Get in touch with your doctor if your urine becomes thick/dark, if you are unable to empty your bladder or you have large blood clots in your urine.
Percutaneous nephrolithotomy has been proven to be safe and effective since long. It is a minimally invasive surgery and is an indispensable tool in the armamentarium of urologists for the treatment of renal stones.
How to find and reach urologists fornephrolithotomy procedure ?
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
