Percutaneous Nephrolithotomy (PCNL)
Percutaneous Nephrolithotomy, commonly known as PCNL, is a minimally invasive surgical procedure designed to remove kidney stones that are either too large, too numerous, or too complex to be effectively treated with noninvasive methods such as extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy. PCNL is particularly recommended for stones larger than 2 cm, staghorn calculi (branched stones filling a large portion of the kidney), or stones resistant to other treatments.
Preoperative Preparation
Prior to undergoing percutaneous nephrolithotomy, patients usually undergo various evaluations, such as CT scans, X-rays, and ultrasounds, to establish the exact size, location, and composition of the kidney stones. Blood and urine tests are also done to assess the patient’s overall health status and identify any infections or abnormalities that must be treated before surgery commences.
Stone Removal
After tract formation, a nephroscope, a kind of endoscope meant for looking inside the kidneys, will be inserted into the incision so that kidney stones may be seen.
Different techniques, such as laser lithotripsy, ultrasonic waves or pneumatic lithotripsy, are used to crush the stones.
Stone fragments can then be removed through special graspers or suction devices. In rare cases, a basket-like device is used to remove the stone in one piece.
Post-Procedure:
Once the remaining stones have been removed, a nephrostomy tube might be briefly placed into the kidney to allow urine drainage and ensure that any small remnants pass quickly.
During the healing process, it can also involve placing a stent inside the ureter to help with proper drainage from the kidney to the bladder.
Long-Term Recovery
Most patients will be able to return to normal activities after about 1 or 2 weeks following surgery; however, they should avoid strenuous activities for several weeks afterwards.
Follow-up visits with a urologist enable evaluation of wound healing progress and discussion of possible adjustments in diet or lifestyle necessary for preventing future stone formation.
Advantages of PCNL
Minimally Invasive: Compared to open surgery, PCNL involves smaller incisions, resulting in less pain afterwards, shorter hospitalizations and faster recuperation times than would otherwise occur if open surgeries were done
High Success Rate: PCNL is highly effective in removing large and complex kidney stones in a single treatment session
Lower Risk of Recurrence: By effectively eliminating even larger staghorn calculi, which are hard-to-treat stones made up of branching structures encasing most of an entire kidney, such as calyxes and pelvises, PCNL decreases the chances of reappearance and reduces the need for additional therapy sessions.
Risks and Complications
While in most cases, PCNL is considered safe, there are some risks associated with this procedure, just like any other surgery
Bleeding: there will be some bleeding, but sometimes it may be severe enough to require a blood transfusion.
Infection: even with prophylactic antibiotics, there is a chance of developing post-surgical kidney or urinary tract infections.
Injury to Surrounding Organs: On occasion, adjacent organs such as the small intestines, spleen, or liver can be unintentionally damaged during the operation.
Residual Stones: Tiny pieces may remain behind, thus prompting additional treatment.
