What is percutaneous nephrolithotomy?
Percutaneous nephrolithotomy (PCNL) is a medical procedure used to remove large or complex kidney stones from the ureter – the tube that drains urine from the body. It is a minimally invasive surgery that involves making a small incision in your back and inserting a thin tube (known as a nephroscope) directly into the kidney.
PCNL is effective for stones that are too large for the body to pass on their own and too large to be treated with other non-invasive methods such as lithotripsy and ureteroscopy. It is considered a safe and effective procedure for kidney stone removal, and recovery time is relatively short compared to open surgery.
How does percutaneous nephrolithotomy work?
PCNL works to effectively remove kidney stones that cause significant pain and are too large to pass naturally.
The steps for a percutaneous nephrolithotomy are as follows:
- You will undergo various medical tests to identify the exact size and location of the stone.
- Depending on your situation, general anaesthesia (puts you to sleep) or spinal local anaesthesia (lower body part while keeping you awake) will be used.
- A small incision will be made in your back, typically on your side, to access your kidney.
- Through this incision, a thin tube (nephroscope) is inserted.
- Your urologist will use imaging guidance (x-ray, ultrasound) to identify the kidney stone’s exact location and guide various instruments to break the stone into smaller pieces.
- These fragments are then removed through the nephroscope using a small basket or vacuum-like device. A laser may sometimes be used to help fragment the stone.
- After the stone fragments are removed, a small tube or drain may be temporarily left to facilitate drainage of any remaining fluids or blood from your kidney.
- At the end of the procedure, the incision is closed with stitches or adhesive strips, and a sterile dressing is applied.
- Most patients can return home within 1 or 2 days, although recovery time varies depending on the size and complexity of the stone(s).
Benefits of percutaneous nephrolithotomy
- Minimally invasive
- Faster recovery
- Less post-operative pain
- Reduced risk of kidney damage
- Improved kidney function
- Low risk of infection or complications
- Less scarring
- High success rates
What conditions can percutaneous nephrolithotomy treat?
A percutaneous nephrolithotomy can be used to treat the following:
- Large kidney stones that cannot be passed naturally
- Complex or multiple kidney stones
- Stones causing severe pain or kidney damage
- Blockage of urine flow
- Recurrent kidney stone formation
What results can I expect?
You can expect several outcomes after undergoing a PCNL to remove kidney stones; these are:
- Stone removal: PCNL is highly effective at removing kidney stones. You can anticipate relief from any pain and discomfort associated with these stones.
- Improved kidney function: PCNL can restore normal kidney function. This means better filtration of waste products and maintaining your body’s fluid balance.
- Reduced risk of infection: kidney stones can lead to urinary tract infections (UTI). Removing them through PCNL minimises the risk of recurrent infections.
Generally, PCNL is safe and effective. However, outcomes vary from person to person depending on the size and location of the stones and your overall health.
How many treatment sessions are needed?
The number of treatment sessions required for PCNL varies depending on several factors, namely the size and complexity of the kidney stones and your overall health.
PCNL can be conducted in the following ways:
- Single procedure: in many cases, PCNL is done in a single session that successfully removes kidney stones. If your stones are relatively small or located in a way that allows for complete removal during the initial PCNL, you may not need additional sessions.
- Multiple procedures: for larger or more complex stones, or if there are multiple stones in one or both kidneys, you may require multiple PCNL sessions. Your urologist typically makes this decision based on the specifics of your condition.
- Staged PCNL: in some situations, mainly if there are significant health concerns or a large stone burden, PCNL may be staged. This means the procedure is done in 2 or more sessions to ensure safety and effectiveness.
Frequently asked questions
During PCNL, you will not feel pain as you are under general or spinal anaesthesia. However, after the procedure, some discomfort is common. This can be managed with pain medications prescribed after the procedure.
Generally, a single PCNL session takes 1 to 3 hours. This depends on factors such as the complexity and size of the kidney stone(s) being treated.
The recovery period after PCNL varies but generally takes several days to a few weeks.