What to expect before the Surgery?
- Prior to the Percutaneous nephroLithotomy, you will meet with the surgeon for a pre surgical consultation where you will be examined and certain blood tests, urine tests and diagnostic imaging will be ordered. These include:
- EKG (electrocardiogram)
- CBC (complete blood count
- PT / PTT (blood coagulation profile)
- Comprehensive Metabolic Panel (blood chemistry profile)
- Urinalysis and Urine Culture
- After a detailed review of your medical history, your surgeon will perform a brief physical examination.
- On the day of the procedure, you will receive an antibiotic, either by mouth or an IV, right before the procedure.
- You will be put under general anesthesia for the surgery
How is the procedure performed?
- The length of the surgery may go upto 3 to 4 hours
- The procedure is performed by making a 1 cm incision in the back
- After the administration of anesthesia, your surgeon will perform a telescopic examination of the bladder and instill x-ray dye or carbon dioxide into the kidney.
- This is done through a small catheter that is placed up through the ureter or drainage tube of the kidney that is to be treated
- This procedure allows your surgeon to exactly locate the stone within the kidney as well as place a small needle through the skin under x-ray guidance to directly access the calculi.
- If required, a laser or other device such as a lithotripter will be used to break up the calculi before it can be removed from the body
What to Expect After Surgery?
- Once the Percutaneous nephroLithotomy is successfully completed, you will be shifted to the recovery area where you will be monitored for the next few days.
- A tube will be placed to drain out the urine and you will notice some blood mixed with the urine in one or both tubes.
- After the post-op blood in the urine has decreased enough, the tube might be removed.
- If not removed on the day after surgery, the tubes are removed the following day.
- After tubes are removed, and after you have been able to urinate, you are discharged from the hospital.
- You will be prescribed with medication for pain relief as well as antibiotics
- Schedule a follow-up visit with your urologist about 6 weeks after surgery when an X-ray will be taken to make sure the procedure has gone well
What to do after returning home?
- Walk daily to mobilize the area and minimize the risk of blood clots, called deep vein thrombosis
- Prolonged sitting or lying in bed should be avoided and change positions during the day
- You can climb stairs after a few days but take it slowly.
- Do not drive until you have stopped taking the prescribed pain medication
- You will be able to return to work in about 1-2 weeks after the surgery or as advised
Nephrostomy Site Care:
- It is very important to care for your nephrostomy site to ensure proper healing of your kidney.
- The urine must flow freely into the drainage bag, and it should be kept below the level of your kidney at all times.
- Gently clean the area around the tube insertion site with a mild soap and water every day
- The ureteral stent is usually removed within 1-2 weeks following surgery and the time will be determined by your surgeon.
- When the stent is still on, it is common to feel a slight amount of fullness in the flank area and also an urgency to void urine.
- These uncomfortable symptoms get better and improve with time as the body adapts itself to the stent placed.
- When it is time to remove the stent, it is done through cystoscopy when your surgeon will put in a small flexible telescope into the urethra to visualize and thus hold the end of the stent that dwells in your bladder.
Percutaneous nephrolithotomy – Are you the right candidate
If you have large kidney stones or other stones, then removal methods are not for you. In that scenario, the doctor recommends Percutaneous nephrolithotomy. It is a minimally invasive surgery done to remove kidney stones. After this surgery, you can expect a 90 percent stone-free rate, the highest of all other stone removal procedures. The surgery is usually recommended in the below-listed situations, comprising:
When A person has large kidney stones blocked in more than one part of the kidney.
When a person’s kidney stones are larger than 0.8 inches (2 cm) in diameter.
When there are larger stones in the ureter
When their treatments for stone removal failed.
Some other possible candidates for the surgery are:
- When a person has damage to the bladder or ureter
- If a person has Blockage in the ureter
- Urethral stricture
- Tumours that cause blockage
Percutaneous nephrolithotomy, also known as PCNL, is a surgical process to remove large kidney stones. After six weeks, a post-surgery patient is asked to consult the doctor again. The doctor may recommend an ultrasound or an X-ray to monitor for any stones that may be left behind and ensure that the kidney is functioning appropriately. Also, in terms of pain, the Percutaneous nephrolithotomy is moderately painful. Your surgeon will prescribe Percutaneous nephrolithotomy pain relievers for pain. The recovery post-surgery will take time, and the recovery period may vary from person to person.
People who should not go for Percutaneous nephrolithotomy
People with severe conditions like heart or lung disease should avoid PCNL surgery. Also, those who experience uncorrectable bleeding disorders and are more prone to urinary infections are not good candidates for PCNL. This is because they are at greater risk of sepsis during the procedure. Handa Nursing Home is the best option if you are seeking PCNL surgery, which is an outstanding procedure for patients with large kidney stones. or if the kidney stone is larger than 15mm. This size of stone is difficult to treat using ureteroscopy or lithotripsy procedures. Patients who have a history of recurrent kidney stones also greatly benefit from the surgery. Moreover, there are many cases of multiple stones in the kidneys or upper ureters that are the reasons for urinary retention; PCNL is the best option considered by the experts as it is the optimum treatment procedure.
What are the Advantages?
- Large or complicated calculi can be treated and removed through a minimally invasive procedure .
- The stone free rate following the procedure is about 97% in patients
- The duration of hospital stay is lesser than an open procedure.
- The recovery time in a Percutaneous nephroLithotomy is significantly shorter than an open surgical approach.
- Quicker return to work is made possible.