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PCNL is a technique used to remove certain stones in the kidney or upper ureter that are too large for other types of stone treatment, such as ESWL or ureteroscopy.

After general anesthesia, a thin tube is inserted into the kidney through the urethra. Then the patient is placed face down and the kidney is found by x-ray. A pinhole is made into the kidney and a wire is inserted through it. Wire is used as a guide to allow a path to expand about 1 cm in diameter. A telescope (nephroscope) is inserted into the kidney and the stone is visualized. The stone is broken into pieces and the pieces are removed. A tube is left in the kidney so that the urine can be drained easily.

Because this is an invasive surgery, the renal tract heals with a scar as small as one millimeter. For the long term, these are very minor changes and have no effect on the normal function of the kidney.

The process takes 60 – 90 minutes. It does not include the time taken for the anesthetist to put the patient to sleep or wake up. The hospital stay is usually 2-3 days.

PCNL is the most effective way to treat large stones in the lower part of the kidney. A successful PCNL clears all the stones. The success of the operation varies between 95% in lower pole stones and 90% in Staghorn stones. Success depends on the size and on the position of the stone.

As the duration of surgery increases, the risk of PCNL increases with the size of the stone. Breaking a large stone into removable pieces also increases the likelihood of kidney damage.

 1) Bleeding – Some bleeding can be seen, but more bleeding is rare (1%).
A) Early bleeding – If very severe, conersion to open surgery may be necessary to stop the bleeding if all other measures fail. This is extremely rare.
B) Subsequent bleeding – (0.5% – 2%) This occurs if a communication develops between an artery and a vein near the puncture site. It is treated by occlusion of the connection by means of a catheter passing through the groin. (selective renal angiography).
2) Infection: Infection of the urine before surgery is not uncommon. Some stones contain bacteria released during the process. Antibiotics are given routinely. This reduces the risk of infection. Serious infection occurs in approximately 0.25% of patients.
3) Rare complication
A) Intestinal injury – an abnormally placed intestine can be damaged during needle puncture. About 2% of people have this anomaly, but intestinal injury is much less common.
B) Lung Injury – For a while, the pinhole lung may pass through. But extremely rare.
C) Absorption of large volumes of liquid may occur after a long procedure.

Post PCNL Surgery

After surgery

Drink plenty of fluids - this will make passing urine easier and more comfortable.
Avoid constipation - forcing the bowels to open will increase the risk of bleeding
Get out of bed – lying in bed causes pneumonia and clots in the legs.
 

Don't do!


No heavy lifting/straining for four weeks
No driving until you can comfortably do everything at home by yourself.

Percutaneous Kidney Stone Surgery (PCNL)

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