Percutaneous Nephrolithonomy (PCNL)

Kidney stones are formed in the urinary tract due to crystallization of chemical compounds in the urine. PCNL is a method used to remove certain stones in the kidney or upper ureter (the tube that drains urine from the kidney to the bladder) that are too large for different varieties of stone treatment such as shock wave lithotripsy or ureteroscopy.

The Surgery

This procedure has been carried out on many patients over the remaining several years and is accepted standard of care for patients with kidney stones that are large, very firm, or resistant to different varieties of stone treatment. As such it has changed open operations for kidney stones in the vast majority of patients.

Typically, the length of the surgery is three to four hours. The surgical operation is performed by making a small 1 cm incision in the patient’s flank area. A tube is placed through the incision into the kidney below x-ray guidance. 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 imperative a laser or different system known as a lithotripter may be used to break up the stone earlier than it can be removed. This procedure has resulted in significantly less post-operative pain, a shorter hospital stay, and earlier return to work and each day activities when compared to open stone surgery.

This technique also has a higher success rate for clearing all stones in one setting than different strategies such as extracorporeal shock wave lithotripsy (ESWL), which often require several attempts.

Potential Risks and Complications

Although this technique has proven to be very safe, as in any surgical method there are dangers and potential complications. The safety and complication rates are comparable when in contrast to the open surgery. Potential risks include:

• Bleeding: Some blood loss will happen with this process however rarely do patients require a blood transfusion. If you are fascinated in autologous blood transfusion (donating your own blood) you must make your surgeon aware. When the packet of information is mailed to you related to your surgery, you will also receive an authorization form for you to take to the Red Cross. You have to coordinate this with the Red Cross in your area.
• Infection: All patients are treated with broad-spectrum antibiotics to limit the risk of infection from occurring after surgery. If you advance any signs or signs of infection after the surgery (fever, drainage from incision, urinary frequency or discomfort, pain or anything that you may be worried about) please contact us at once.
• Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue/organs including bowel, vascular structures, spleen, liver, lung, pancreas and gallbladder could require further surgery. Loss of kidney feature is rare but is a potential risk. Scar tissue may also structure in the kidney or ureter requiring further surgery.
• Conversion to open surgery: This surgical procedure may require conversion to the standard open operation if challenge is encountered during this procedure. This could result in a larger standard open incision and possibly a longer recuperation period.