- PCNL stands for Percutaneous Nephrolithotripsy also popularly known as laser kidney surgery or keyhole surgery for kidney stones treatment
- A hole is made through the kidney upto the stone and the stone is broken into peices and extracted
- Recommended for stones more than 1 cm of size
- Requires 2 -3 days stay in the hospital
- Requires placement of DJ stent
What are the kidney stones ?
Kidney stones are formed due to deposition of crystals within the kidney. These crystals keep enlarging in size with time and lead ultimately to the formation of stones. Initially the deposition of crystals take place over the filter of the kidney. As the deposition keeps increasing layer by layer, the stone starts to become heavy and ultimately when it becomes to large and heavy it falls into the urinary collecting system. This happens in the same way as the ripening fruit falls off a tree.Once the stone is in the collecting system of the kidney it if free to move and block the passage of the Urine flow and damage the kidney.
What are the treatment options for kidney stones?
Stones less than 6 to 8mm can be managed conservatively with the help of stone inhibitors and increase in fluid intake. Those larger than this size need to be managed by an invasive procedure. Lithotripsy can be offered for stones upto 2 cm in size but pcnl remains the gold standard or procedure of choice for removal in one go.
What is PCNL?
Percutaneous Nephrolithotomy is an endoscopic surgery for removal of kidney stones in which a small puncture is made into the kidney through the back and the stone is broken down into small pieces and removed.The incision made in the back is about 6 to 8mm.
Preparing for surgery
To prepare for this surgery you must take the following steps:Stop any blood thinners or anti-platelet drugs like aspirin/clopidogril atleast 5-7 days prior to the procedure. Shave the pubic hair 3 days prior to the procedure or trim the hair on the day of the procedure. Take a shower on the day of the procedure and wear clean clothes. Make sure that you empty your bowel on the day of the procedure or a night prior. Ensure that you are fasting for atleast 8 Hours prior to your scheduled time of surgery. If the Surgery is in the morning then you should not eat or drink anything after dinner (except your recommended medication with sips of water). If the surgery is scheduled in the afternoon then you may have your breakfast by 8 am.
Once you are in the hospital you will be asked to fill the admission request form and sign a consent that informs you about the risks and benefits of the procedure. An Intravenous line will be established and fluids will be started. You will be shifted to the operating suite 10 minutes prior to the scheduled procedure.
- Shifting to the Operating Suite on a wheelchair
- Lying down on the OT Table
- Administration of Spinal Anesthesia / General Anesthesia
- Placement of Ureteric catheter from the urinary pipe into the kidney
- Shifting to the prone position with back facing upwards as this procedure is performed from the back
- Localization of stone and kidney under live X ray
- Puncture is made from the back into the kidney and the puncture is dilated to allow passage of a endoscope called nephroscope
- Laser fibre passed through nephroscope allows fragmentation of the stone
- Stone fragments are removed and a Plastic tube called DJ stent is placed
- Shifting back to the recovery
What happens after the PCNL operation ?
After the surgery you are shifted from the recovery area to your private room. The effect of anesthesia usually lasts for 3 to 4 hours during which time you may not be able to move your legs. You will be administered painkillers to minimize the post operative pain.
Liquids like coconut water or juice will be permitted by the evening of the surgery (Usually after 6 hours). On the following day, semisolids will be allowed and the nephrostomy drain (if placed) will be removed. Once 24 hours after the surgery are completed, you will be permitted to get up and sit down.
By the afternoon of the next day you will be consuming regular diet and be in a position to perform all routine activities. The following morning the urine pipe will be removed and you will be provided the discharge papers.
You have to take rest at home for 3 to 4 days or till your using becomes absolutely clear. There will be no special dietary precautions but fluid intake has to be increased. Also lifting heavy weight is avoided for atleast a month.
The double J stent and the stitch on the back will be removed after 2 weeks. Till that time the stent may cause some urinary symptoms. You can read about these symptoms here.
Complications of PCNL
Common problems after surgery include
- Blood in Urine
- Leakage of urine from the site of surgery which resolves in one to two days
- Stent related frequency
- Mild pain at site of puncture
- Small residual stone dust and fragments that clear out on their own with time
Relatively common complications (1 in 10)
- Persisting fever with chills
- Persisiting blood that gradually reduces
- Persisting large fragments of stone
- Persisting leakage
Uncommon complications (1 in 100)
- Injury to the Ureter
- Inability to access the kidney
- Excessive Bleeding requiring Blood Transfusion
- Need for Dialysis Support
Rare Complications (1 in 1000)
- Formation of a connection between Pleura or the chest cavity and the kidney due to injury during surgery that requires placement of a chest tube
- Formation of a connection between the kidney and the large intestine
- Formation of a Pseudo-Aneurysm that may require angioembolization in a radiology suite
- Need to remove the Kidney