PCNL (Percutaneous Nephrolithotomy) Surgery

Overview

Kidney stones and urethral stones that are too large, dense, or numerous need to be treated with extracorporeal shock wave lithotripsy (ESWL), or ureteroscopy. But, the PCNL procedure is minimally invasive to remove kidney stones.
PCNL (Percutaneous Nephrolithotomy) incision is made of around 1 cm, and this helps in reducing the pain, blood loss, blood transfusion, incision size, and shorter hospital stay. The technique also has a higher success rate for clearing the stones in just one sitting as compared to other treatment options like ESWL which need more than one treatment.

What happens before the consultation?

The patient needs to get the X-ray done and then give all the reports to the surgeon. The doctor will review your medical history and do a physical examination. The doctor will discuss all the possible treatment options which can benefit your condition.

What happens before the surgery?

The surgery date is fixed and your personal information will be noted down. The procedure is performed with preoperative anesthesia which the doctor will prepare for you during the initial visit. You will get the opportunity to speak with the doctor and nurse regarding the anesthesia type along with its risk. Some of the tests which can be performed include:

• Physical exam
• EKG (electrocardiogram)
• Comprehensive Metabolic Panel (blood chemistry profile)
• CBC (complete blood count)
• PT / PTT (blood coagulation profile)
• PT / PTT (blood coagulation profile)

Is it important to avoid medications before the surgery?

Before the surgery, for at least 7 to 10 days you need to avoid the surgery. This is because they can lead to clots and unwanted bleeding during the surgery. Make sure to inform your doctor about all the medications you are taking. Some of the medications include:
Aspirin, Alka Seltzer, Vitamin E, Ticlid, AdvilCoumadin, Lovenox, Motrin, Ibuprofen, Celebrex, Voltaren, Vioxx, and Plavix.

What about the surgery?

The PCNL surgery is performed under general anesthesia, and the patient needs to lie on the abdomen. After that, cystoscopy is performed and instills X-ray dye or carbon dioxide into the kidney with the use of a small catheter which is placed through the ureter. This helps the surgeon to check the stone location in the kidney, and place a small needle to access the stone with the help of an X-ray.
The needle is placed around 1cm to see the stone. Smaller pieces are taken out from the body with the help of mechanical, ultrasonic, or laser lithotripsy. It might be possible a small ureteral stent is left for the drainage in the kidney to the bladder. The entire surgery will take around 3 to 4 hours.
After the surgery, the doctor will give you specific instructions that you need to follow to get successful results and recover smoothly.

How PCNL is beneficial as compared to other treatments?

The main benefit of undergoing PCNL over other treatments is that it follows a minimally invasive approach to treat and remove large stones in a single session.