PCNL or Percutaneous Nephrolithotomy is a procedure that is performed to remove stones in the kidney or upper part of the ureter. This procedure is ideal for stones that are too large for removal by other forms of renal stone treatment such as “Shock Wave Lithotripsy” or “Ureteroscopy”.
Micro PCNL is a modification of the PCNL technique where a much smaller needle is used – 4.85F and has clear advantages over standard PCNL.
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