Percutaneous Nephrolithotomy is the surgery used to perform to treat medium to large kidney stones.Kidney stones are small pebbles initially and become stones later, after growing in the size. These are formed by crystal aggregation of the dietary mineral present in the urine. They are formed in different locations in the kidney. These might be present in bladder or ureter. These are also classified on the basis of the chemical composition, like having uric acid, struvite or calcium. After the stones are grown more than 3 mm size, they cannot be passed through the urine and start causing the symptom. Mostly men are affected from the kidney stone problems.
Kidney stone has another name in medical industry, as renal calculi. The stones are made by solidification from the deposits of calcium salts that are highly concentrated, especially when found with the kidneys. These kidneys stay for some time inside the kidney and may start moving down through the urinary tract. The size of the kidney varies in size. Small stones are usually passed out from the body with no pain or causing a little pain. But the larger stones are stuck in the urinary tract and it blocks the urine flow. When the urine is stopped in such way, bleeding or severe pain is occurred.
The purpose of PCNL is the removal of renal calculi in order to relieve pain, bleeding into or obstruction of the urinary tract, and/or urinary tract infections resulting from blockages. Kidney stones range in size from microscopic groups of crystals to objects as large as golf balls. Most calculi, however, pass through the urinary tract without causing problems.
Renal calculi are formed when the urine becomes supersaturated (overloaded) with mineral compounds that can form stones. This supersaturation may occur because the patient has low urinary output, is excreting too much salt, or has very acid urine. Urolithiasis is the medical term for the formation of kidney stones; the word is also sometimes used to refer to disease conditions associated with kidney stones.
How is the Percutaneous nephrolithotomy (PCNL ) Surgery performed?
While you are under the general anaesthetic the surgeon will examine your bladder with a long, thin, semi-rigid or flexible telescope and pass a small tube up to your kidney, which has the stone. This is used to pass a mixture of a coloured dye and x-ray dye to the kidney making it easier to see during the operation.
You will then be placed face down on the operating table and the consultant will make one or more small incisions into your back. This is done using special metal or balloon dilators (see diagram). This enables the consultant to pass a telescope into your kidney.
The stone or stones in the kidney are then removed either intact or in pieces after breaking them with special instruments. X-rays will be taken during and at the end of the procedure to ensure that all accessible bits of the stone have been removed from your kidney.
A telescope is passed down into the kidney so that the surgeon can see the stone. The stone is broken up and then the pieces are removed using a special instrument.
You have been diagnosed as having a kidney stone (or stones) causing some, or all, of these symptoms: pain, infections, bleeding or obstruction of your kidney, which if left untreated, may lead to further symptoms or complications, such as severe infection or loss of kidney function. This operation (PCNL) is performed to remove large kidney stones using a keyhole approach. This is a major operation despite the term ‘keyhole surgery’. The procedure requires a general anaesthetic and may last 1 to 3 hours with a hospital stay from 4 to 7 days. The success rate of kidney stone clearance ranges from 75% to 100% depending on various factors.
What can I expect after the Percutaneous Nephrolithotomy (PCNL)?
• There will be a catheter in your bladder to drain your urine. Your urine may be coloured with blood or bluish-green dye used during the procedure. The catheter will be removed once you are up and about or when the consultants are satisfied with your progress
• There will be a tube in your back connected to a drainage bag to allow the kidney to drain a mixture of blood and urine. The blood in this tube will gradually clear in a day or two. Occasionally further x-rays may be necessary before this tube is removed. Removing the tube does not usually require any painkillers or sedation
• There will be a drip in one or both of your arms to give intravenous fluids until you are able to drink and eat normally. This may sometimes be used to give a blood transfusion if required
• You may be given antibiotics post-operatively either orally or through the drip in your arm
• You will be prescribed and given appropriate painkillers after the procedure
• Complicated or larger stones are allowed to be treated in minimally invasive method, unlike the past methods, which demanded larger incisions over the skin.
• PCNL is considered to be an effective procedure, as it achieves better results and stone-free outcomes.
• The pain medication required for the surgery would be half of the usual pain medication requirement, for many of the patients.
• Stay in hospital would be decreased to 3 to 4 days. Even the recovery time, out of the hospital is also much reduced than the traditional open surgery treatment.
You may want to ask some questions before your treatment begins: