Per-urethral Catheterization Lithotripsy (PUCL:
Pre-Operative Preparation
Usually, prior to PUCL, patients undergo imaging such as ultrasound, X-ray, and CT scan to ascertain the number, size, and location of stones within them. Blood and urine tests may also be done to assess kidney function while checking for any infection and other conditions in an individual patient that might affect this process.
Per-urethral Catheterization Lithotripsy (PUCL)
Per-urethral Catheterization Lithotripsy (PUCL) is a minimally invasive medical procedure for the treatment of urinary stones, especially in the bladder or lower ureter, those that cannot get out naturally via the urinary tract. The process involves inserting a catheter into the urethra to reach the stone and subsequently breaking it apart before taking it out. PUCL is usually performed when stones are more significant than what can pass naturally or if they cause severe symptoms, including but not limited to pain, blockage, and recurrent UTIs.
Per-Urethral Catheterization Lithotripsy (PUCL): A Breakdown
Per-urethral catheterization Lithotripsy (PUCL) is a medical procedure used to treat urinary stones, particularly those located in the lower urinary tract. It combines two techniques: catheterization and lithotripsy.
The PUCL Procedure
Catheter Placement
A catheter is inserted into the urethra and positioned to access the stone.
Stone Localization
The exact location and size of the stone are determined using imaging techniques like X-ray or ultrasound.
Stone Localization
The exact location and size of the stone are determined using imaging techniques like X-ray or ultrasound.
Stone Passage
The fragmented stone particles are typically passed out of the body naturally with urine. However, in some cases, a second procedure may be needed to remove larger fragments.
Advantages of PUCL
Minimally invasive: Unlike open surgery, PUCL involves smaller incisions or no incisions at all.
Unlike open surgery, PUCL involves smaller incisions or no incisions at all.
Compared to other stone removal procedures, PUCL is often associated with less post-operative pain.
Patients usually require a shorter hospital stay compared to open surgery.
Not for all stones: Smaller stones in the lower urinary tract are mostly cured by PUCL. On the other hand, bigger ones or those found elsewhere in the urinary system will need different modes of treatment.
The procedure starts when the patient is under general anesthesia. To create a direct pathway to the kidney, a small cut, usually about 1 cm, is made at the back. Through this incision, a surgeon inserts a thin tube-like instrument known as a nephroscope, guided by imaging techniques such as fluoroscopy or ultrasound. The nephroscope allows the surgeon to see the stones and tissues in close proximity to the kidneys directly.
PCNL has high success rates above 90% depending on patient selection. Where properly applied, it should completely eliminate all stone burden. Some advantages over open surgery include smaller incisions, less blood loss, shorter hospital stays, and faster recovery time. Most patients return to their normal activities within several weeks, although full recovery may take longer due to the complexity of each patient’s case.
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Complications that may arise
Just as with any other medical procedure, PUCL presents risks such as bleeding, infections, and obstruction of urinary passages.
In fact, this is a highly specialized procedure that experienced urologists should carry out. The decision to undergo PUCL depends on several factors, including the size and location of the stone(s), the patient’s overall health condition, and the availability of other treatment options.
Would you like to know about the dangers associated with this method, recovery steps, or alternative treatments for kidney stones