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PCNL (Per-cutaneous Nephro-lithotomy)
A. PCNL involves disintegration and extraction of kidney stones with a telescope placed into the kidney through a small puncture in the back.
This usually includes cystoscopy and x-ray screening.
A. External shock wave treatment (ESWL), open surgical removal of stones (Open Pyelolithotomy or nephrolithotomy), Retrograde intra-renal surgery (RIRS) and observation.
PCNL is used most often when kidney stones are too difficult to reach, too large, too numerous, or too dense to be treated by shock wave lithotripsy or ureteroscopy
A. If you are taking blood thinning medication on a regular basis, you must discuss this with your urologist because these drugs can cause increased bleeding after surgery. There may be a balance of risk where stopping them will reduce the chances of bleeding but this can result in increased clotting, which may also carry a risk to your health. This will, therefore, need careful discussion with regard to risks and benefits.
You will usually be admitted a day before or on the same day as your surgery. You will normally undergo pre assessment on the day of your clinic or an appointment for pre assessment will be made from clinic, to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the consultant, junior urology doctors and your named nurse. An x-ray may be taken in advance of surgery to confirm the position of your stone(s).
You will be asked not to eat or drink for six hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy.
If you are admitted on the day before surgery, you will normally be given antibiotics into a vein to prevent any infection at the time of surgery.
Please be sure to inform your urologist in advance of your surgery if you have any of the following:
A. Normally, a full general anaesthetia or spinal anaethesia will be used and you will be asleep throughout the procedure. You will usually be given injectable antibiotics before the procedure, after checking for any allergies.
The operation is usually carried out in a single stage. First, a small tube is inserted up the ureter into the kidney by means of a telescope passed into the bladder. You are then turned on to your face and a puncture track into the kidney is established, using x-ray guidance. Finally, a telescope is passed into the kidney and the stone(s) extracted or disintegrated. A catheter is usually left in the bladder at the end of the procedure together with or without (tubeless) a drainage tube (DJ Stent) in the kidney. The DJ-stent remains in place by J-shaped curls in both the kidney and the bladder.
It may be necessary to puncture the kidney at more than one site if you have many stones scattered throughout the kidney.
A. On the day after surgery, a further x-ray may or may not be performed to assess stone clearance. Occasionally, it may be necessary to perform an x-ray down the kidney drainage tube using contrast medium. If the x-ray is satisfactory, the tube in your kidney and the bladder catheter will be removed. There is often some leakage from the kidney tube site for 24 to 48 hours.
The average hospital stay is 2-3 days.
A. Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after an urological procedure.
Common (greater than one in 10)
Occasional (between one in 10 and one in 50)
Rare (less than one in 50)
A. When you leave hospital, you will be given a discharge summary of your admission. This holds important information about your inpatient stay and your operation.
When you get home, you should drink twice as much fluid as you would normally to flush your system through and minimise any bleeding. You should aim to keep your urine permanently colourless to minimise the risk of further stone formation.
It may take at least two weeks to recover fully from the operation. You should not expect to return to work within 10 days, especially if your job is physically strenuous.
Double-J stent: If a DJ-stent was placed during the procedure and was not taken out before your hospital discharge, your doctor will tell you when it needs to be removed. This can take anywhere from several days to a few weeks.
Nephrostomy tube: If a nephrostomy tube was placed during surgery, you may have it for a short while. Taking care of your nephrostomy tube is important to ensure proper healing of your kidney. Your doctor will give you the necessary instructions
A. If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your urologist immediately. Small stone fragments may also pass down the ureter from the kidney, resulting in renal colic; in this event, you should contact your urologist immediately.
A.
A. When you have:
A. A follow-up appointment will be scheduled with you prior to discharge from the hospital. This appointment might be necessary for:
A. Yes, you will need day-care admission. DJ stent will be removed under short general anesthesia.
A. You can prevent further stone recurrence by implementing changes to your diet and fluid intake. You can find the details in the relevant section on the website.