What does the procedure involve?
This is a procedure used to treat large kidney stones. A small tube is inserted into the kidney through the back. A nephroscope (a special telescope) is then inserted into the kidney, through which the stone can be disintegrated and removed.
Who needs PCNL?
PCNL is usually required for large stones in the kidney – especially the type described as staghorn stones (stones that assume the shape of the inside of the kidney they are that large). The big advantage of PCNL over some of the alternatives, is that for the vast majority of people it allows the complete removal of the stone in one treatment. The alternatives usually require two or more procedures.
What are the alternatives?
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ESWL – Extracorporeal Shock Wave Lithotripsy. A shock wave is used to fragment the stone, the pieces are then passed in the urine over the following 2-3 weeks.
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Laser Lithotripsy – the stone is broken up using laser energy through a special telescope (flexible pyeloscopy) that is inserted up to the kidney via the bladder. Stones >1cm usually require multiple procedures.
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Observation – some stones if pain free and not causing damage to the kidney may be safely watched under a surveillance regime.
What happens during the procedure?
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You will have a general anaesthetic.
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You will be given an injection of antibiotics before the procedure.
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Initially a cystoscopy (telescope inspection of the bladder) is performed to place a small catheter into the kidney. This allows X-ray imaging to be performed that directs the main procedure.
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You will then be placed in the prone position – i.e. face down on the operating table to allow access to your back.
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Under X-ray guidance a small tube (nephrostomy tube) in positioned in the kidney. A Radiologist is often in the operating theatre to perform this part of the procedure.
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Once access to the kidney has been established the nephroscope (kidney telescope) is used to visualize the stone.
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Using either laser or ultrasound energy the stone(s) are broken into small enough pieces to be removed through the small nephrostomy tube.
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A flexible nephrostomy tube is left inside the kidney – they in different sizes according to what you need. It is usually removed the next day.
What happens during your hospital stay?
Apart from the nephrostomy tube (the tube in your back), you will usually have an indwelling catheter inserted. Both these tubes are usually removed the next day once it has been determined it is time to do so. Occasionally, you may have further X-rays before this is done.
The nephrostomy tube is usually clamped for 2-3 hours before its removal. This allows time for you to see if you get any pain that might indicate there is still some swelling in the area of the kidney outlet that is causing some blockage. If you do experience such pain the nurse will unclamp the nephrostomy – the pain will recede. It is unusual to require the nephrostomy for more than 48 hours.
You will usually be discharged 24-72 hours after your operation. The site may leak for 24 hours, so there is no need to worry if it does.
Are there any side effects?
Most procedures have possible side effects. But, although the complications listed below are well recognised, most patients do not suffer any problems.
Relatively Common
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Blood in the urine (temporary).
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Raised temperature (temporary).
Occasional
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Occasionally the surgeon will need to make more than one puncture.
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There is no guarantee all the stones will be removed and you may need further operations.
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You may get new stones.
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The surgeon may not be able to get access to the kidney and you may need further surgery.
Rare
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Severe kidney bleeding requiring transfusion or embolization.
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Damage to the lung, bowel, spleen, or liver – which will need surgery.
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Kidney damage or infection needing further treatment.
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Irrigating fluids may get into the blood system and cause a strain on the heart.