(PCNL)

Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large kidney stones (nephrolithiasis) that are difficult to treat with other methods. It’s typically recommended when stones are too large to pass naturally or when other treatments, such as shock wave lithotripsy (SWL), are not effective.

Procedure Overview

1. Preparation:

   • Anesthesia: General anesthesia is administered.
   • Positioning: The patient is usually placed in a prone position (lying face down) or sometimes in a modified supine position, depending on the surgeon’s preference and the location of the stones.

2. Incision and Access:

   • A small incision (usually less than 1 cm) is made in the back to create a direct access path to the kidney.
   • A guide wire is inserted through the incision and into the kidney, often with the aid of imaging techniques such as fluoroscopy (X-ray) or ultrasound.

3. Instruments and Stone Removal:

   • A sheath is inserted over the guide wire to provide access to the kidney.
   • Specialized instruments, including a nephroscope (a thin tube with a camera) and stone removal tools, are introduced through the sheath.
   • Stones are visualized and broken into smaller pieces if necessary, and then removed using suction or grasping tools.

4. Closure:

   • Once the stones are removed, the incision is closed, and a nephrostomy tube (a small tube inserted through the back) is often placed to drain urine from the kidney while it heals.
   • The nephrostomy tube is usually removed once the kidney is functioning normally and healing is progressing well.

Recovery and Aftercare

• Hospital Stay: Typically 1-2 days, though this can vary based on the complexity of the procedure and individual recovery.
• Nephrostomy Tube: If placed, it is usually removed within a few days.
• Pain Management: Some discomfort and pain are normal, but this can usually be managed with medications.
• Activity: Most patients can resume normal activities within a few weeks, although strenuous activities should be avoided during the initial recovery period.
• Follow-Up: Regular follow-up appointments are necessary to ensure that the kidney is healing properly and to monitor for any potential complications.

Potential Risks and Complications

• Infection: Risk of urinary tract infections or wound infections.
• Bleeding: Internal bleeding or hematoma (blood clot) formation.
• Injury: Possible injury to surrounding organs or tissues.
• Hydronephrosis: Swelling of the kidney due to a build-up of urine.

Benefits

• Effective for Large Stones: Particularly useful for stones too large for other treatments.
• Minimally Invasive: Less invasive than traditional open surgery, leading to shorter recovery times.
• High Success Rate: Generally very effective at removing stones and relieving symptoms.

If you’re considering PCNL or have been advised to undergo the procedure, discussing it with your urologist or surgeon will help you understand the benefits, risks, and what to expect during recovery.