Percutaneous Nephrolithotomy or PCNL as its widely known is a surgical procedure is performed under local anesthesia and intravenous sedation. Percutaneous (i.e., through the skin) removal of kidney stones (lithotomy) is accomplished through the most direct route to stones through the kidney.
How is this done?
A Retrograde pyelogram is done to locate the stone in the kidney. With a small 1 centimeter incision in the loin, the Percutaneous nephrolithotomy (PCN) needle is passed into the pelvis of the kidney. The position of the needle is confirmed by fluoroscopy. A guide wire is passed through the needle into the pelvis. The needle is then withdrawn with the guide wire still inside the pelvis. Over the guide wire the dilators are passed and a working sheath is introduced. A nephroscope is then passed inside and small stones taken out. In case the stone is big it may first have to be crushed using ultrasound probes and then the stone fragments removed.
This procedure achieves a better stone-free outcome in the treatment of medium and large stones than shock wave lithrotripsy. The procedure usually requires hospitalization, and most patients resume normal activity within 2 weeks.
In percutaneous nephrolithotomy or nephrolithotripsy, the surgeon makes a small incision in your back to remove kidney stones. In nephrolithotomy, the surgeon removes the stone through the tube. In nephrolithotripsy, he or she breaks the stone up and then removes the fragments of the stone through the tube. This technique can be used to remove large stones and staghorn stones.
One advantage of percutaneous nephrolithotomy is that the surgeon can remove some of the stone fragments directly instead of relying solely on their natural passage from the kidney.
The surgeon makes a small incision in the back and uses a special instrument to tunnel directly into the kidney. A nephroscope is then placed into the kidney and used to locate and remove the stone. Larger stones may require the use of ultrasonic or other forms of energy to fragment the stone into manageable pieces for removal.
The advantage of this procedure over lithotripsy is the physical removal of the stone fragments rather than relying on their natural passage from the kidney to the outside. This treatment is often used when the stone is large or in a location that does not permit the effective use of ESWL.
When is Percutaneous Nephrolithotomy Used?
ESWL and PCNL are the recommended primary treatment options for renal stones (stone size < 20mm and 20mm or more respectively) in the European Association
This procedure may be used to treat kidney stones that are: Larger than 2cm in diameter.
Large and caused by an infection (staghorn calculi).
Blocking the flow of urine out of the kidney.
Not broken up by extracorporeal shock wave lithotripsy (ESWL).
What Happens before the Procedure?
Most hospitals require patients to have the following tests before a PCNL: a complete physical examination; complete blood count; an electrocardiogram (EKG); a comprehensive set of metabolic tests; a urine test; and tests that measure the speed of blood clotting.
Aspirin and arthritis medications should be discontinued seven to 10 days before a PCNL because they thin the blood and affect clotting time. Some surgeons ask patients to take a laxative the day before surgery to minimize the risk of constipation during the first few days of recovery.
The patient is asked to drink only clear fluids (chicken or beef broth, clear fruit juices, or water) for 24 hours prior to surgery, with nothing by mouth after midnight before the procedur
What to Expect After Treatment?
You will be in the hospital for at least 2 to 3 days. Most people are able to return to work within a few weeks.
Risks of this procedure include
Injury to the colon
Injury to the renal blood vessels
Urinary leak may persist for few days
Holes (perforation) in the kidney. They usually heal without further treatment.