What can you expect:

Before the Procedure:

• Your urologist will take a detailed medical history and perform a clinical examination to determine if you are fit for the surgery

• Laboratory tests, X rays and other imaging will be obtained to help with the surgery.
• You will be prescribed an antibiotic, either orally or through an IV, right before the procedure is performed
• The anesthesiologist will put you under general anaesthesia and you will be monitored throughout the procedure

How is it done?

• After making sure you are under anaesthesia, you will be placed on your abdomen for easy access to the kidney area
• The urologist and radiologist work as a team to place the scope in the part of the kidney that provides access to the stone guided by imaging
• The stone is removed either directly or after disintegrating into smaller fragments.
• The procedure may take about an hour or a few hours depending upon the number and location of the stones
• A plastic tube is left inside at the end of the procedure:
  • An exit tube called a “Nephrostomy Tube,” is left out of the small incision that was made in your back.
  • Another type of internal tube, called a “Stent,” is left inside
  • Your urologist will decide which one to use based on multiple individual factors
  • A plastic catheter is also placed inside your urethra to drain the urine

After the Surgery:

• Following the surgery, you will wake up in the recovery room where you will be monitored
• The urine will drain out of the tube inside the urethra and sometimes another tube will be placed through the incision in your back.
• You may notice that some blood is mixed with the urine in both the tubes
• The day after surgery, if the drainage has decreased as expected, the tubes will be removed
• The tube inside the urethra is removed by deflating the balloon that has kept it in place
• The tube that exits out of the incision in the back is removed after imaging guidance.
• If an internal tube “Stent” has been put in place, in most patients, it is removed while you are still at the hospital
• The stent comes with a thread exiting out of the small incision in your back.
• Sometimes, the stent will be removed weeks later when you visit for a follow-up.
• This is done by a minor procedure after you are discharged from the hospital with a minor procedure in your Urologist’s clinic.
• If the tubes are left in place because the drain did not subside or there was blood in the urine following the surgery or for any other reason related to the surgery, they are removed in the next few days
• Once the tubes are removed, and after you have been able to urinate freely and on your own, you will be discharged from the hospital.
• Sometimes, you will be discharged with one or more tubes still held. In such cases, you and your caretaker will be taught how to take care of those tubes and operate
• You will be prescribed medication for pain relief
• Based on your condition, you may be prescribed antibiotics to be taken after getting home
• You are advised to avoid strenuous activity or heavy lifting for a couple of weeks following the procedure.
• Your pain and risk of infection will subside and will be able to resume normal activities
• A follow-up visit with your urologist will be scheduled about 6 weeks after surgery.
• During the follow-up, an X-ray will be taken to make sure of the procedure’s success and to determine the healing and look at the internal structures
• Depending on your risk of stone recurrence, you will be advised diet and lifestyle changes to maintain a healthy renal system as well as general health

What are the advantages of Micro PCNL?

• It is a minimally invasive procedure
• The duration of hospital stay is shorter
• The healing and recovery is much faster
• The level of incision is much smaller as a specialized needle is used
• Micro PCNL uses an optical needle that allows “Full Seeing” and is in complete view
• The risk of damage to the other internal organs is eliminated because of the needle
• The micro PCNL technique lets the surgeon gain access to the stone in a single step

FAQ’s

Q. What should I avoid after PCNL surgery?

After PCNL (Percutaneous Nephrolithotomy) surgery, it’s crucial to follow your surgeon’s postoperative instructions for a smooth recovery. Generally, you may be advised to:

• Stay Hydrated- Drink plenty of water to help flush out any remaining stone fragments and prevent dehydration.
• Limit Physical Strain- Avoid heavy lifting and strenuous physical activities for a specified period to prevent strain on the surgical site.
• Follow a Special Diet- Your surgeon may recommend specific dietary guidelines to minimize the risk of stone recurrence.
• Take Prescribed Medications- Adhere to any prescribed medications, including pain relievers and antibiotics, as directed by your healthcare provider.
• Attend Follow-up Appointments- Attend all scheduled follow-up appointments to monitor your recovery progress and address any concerns.

Q. What size scope is used in mini-PCNL?

The size of the scope used in mini-PCNL (Miniaturized Percutaneous Nephrolithotomy) can vary, but it is generally smaller compared to traditional PCNL scopes. Miniaturized scopes, often ranging from 11 to 20 Fr (French), allow for smaller access tracts and reduced tissue trauma. The specific scope size depends on factors such as stone size, patient anatomy, and surgeon preference.

Q. What are the advantages of mini-PCNL?

Mini-PCNL offers several advantages, including:

• Smaller Incisions– Mini-PCNL requires smaller access tracts, resulting in reduced trauma to surrounding tissues.
• Faster Recovery– Patients undergoing mini-PCNL may experience a quicker recovery due to minimized tissue damage.
• Decreased Blood Loss- The smaller scope and access tracts are associated with less bleeding during the procedure.
• Lower Postoperative Pain- Patients often report less pain after mini-PCNL compared to traditional PCNL.

Q. What are the complications of mini-PCNL?

While mini-PCNL is generally considered safe, like any medical procedure, it carries some potential complications. These can include:

• Bleeding- Excessive bleeding during or after the procedure.
• Infection- Risk of infection in the urinary tract or surrounding tissues.
• Injury to Surrounding Structures- Rare instances of injury to adjacent organs or structures during the procedure.
• Stone Fragment Retention- The possibility of stone fragments remaining in the kidney.
• Postoperative Pain- Some patients may experience pain or discomfort during the recovery period.

It’s essential to discuss potential complications with your urologist and diligently follow postoperative care instructions to minimize risks and optimize your recovery.