PCNL Surgery for Kidney Stone Removal

Kidney stones causing pain and other discomforts? Get them removed with PCNL Surgery performed at Delhi Urology Hospital, Urology Hospital in Delhi.

PCNL, a medical abbreviation for Percutaneous nephrolithotomy, is a surgical medical procedure to remove a kidney or ureteral stones from the body of an individual who cannot pass the stones through urine on their own.

In earlier times, large kidney and ureteral stones were taken out from the body through an open surgery, wherein a large flank incision was made. Now, a less-invasive surgery called percutaneous nephrolithotomy is performed. “Percutaneous” means through the skin. Unlike traditional open surgery, PCNL surgery is carried out through a small skin incision (of 1cm size). The procedure involves making a passageway from the skin on the back to the kidney. Through this passageway, the surgeon inserts a thin tube into the back to reach the kidney. Special surgical instruments are passed through this tube to locate and remove kidney stones.

As a small cut is made, the PCNL surgery is associated with less pain or discomfort, the patient does not have to go through blood loss or require blood transfusions, and the duration of hospital stay is reduced. Furthermore, PCNL surgery has a high success rate for getting rid of kidney/ureter stones in just one setting than other techniques like ESWL (Extracorporeal Shock Wave Lithotripsy)- which often needs to be done in multiple sittings.

Why is it done?

Percutaneous nephrolithotomy is typically recommended in cases where:

• Kidney stones are larger than 2 centimeters (0.8 inches) in diameter

• Large kidney stones obstruct more than one branch of the kidney collection system. These are called staghorn kidney stones.

• Large stones formed in the tube (ureters) that pass urine from the kidneys to the urinary bladder

• Other therapies to remove kidney or ureter stones have failed.

How to prepare for the surgery?

Before commencing with the PCNL surgery, the surgeon recommends the patient for several tests. These include urine and blood tests to check for signs of infection or other issues. Also, a CT (Computerised Tomography) scan is recommended to locate the stones within the kidney or in the ureters. An EKG may also be asked to check for heart health and a complete physical examination is carried out by the surgeon to confirm the suitability of the patient for PCNL surgery.

At the time of initial consultation, the patient must inform the surgeon about his/her current intake of medications and vitamin or dietary supplements. The surgeon may ask the patient to avoid or discontinue the intake of blood thinning medications or supplements for at least 7-10 days before the secured date of the surgery. An antibiotic course may be prescribed by the surgeon to reduce the chances of infection after the surgery. In case, the patient suspects or has a urinary tract infection, the surgeon must be notified immediately so that appropriate treatment can be provided and the patient then goes ahead with PCNL surgery without risks.

A night before the surgery or 6-8 hours before the operation, the patient is asked to stop eating and drinking to avoid anesthesia-related health risks or complications.

What happens during PCNL surgery?

Percutaneous nephrolithotomy is usually carried out in a hospital setting under general anesthesia with patients lying on their abdomen i.e. face down. Therefore, the patient remains asleep during the entire surgery and feels no pain or discomfort. In some cases, the patient may undergo the first step of the surgery in a radiology department where local anesthesia is provided to numb small areas of the body.

The surgery starts with the insertion of a specialized needle into the kidneys’ calyx- a urine-collecting chamber. The path of this needle later becomes the passageway for the remaining procedure. To guide the insertion and placement of the needle into the kidney, a surgeon or a radiologist takes the help of X-ray, CT-scan, or ultrasound images. This step may take place either in the operation theatre or in the radiology room.

Once the passage is created, a catheter (flexible and thin, hollow tube) is passed through the urethra, urinary bladder, and ureters into the kidneys. Through this catheter, the surgeon instills a specialized tracer substance (X-ray dye or carbon dioxide) into the kidney which outlines the structures inside it so that the branches of the collection system are more visible at the time of imaging. Otherwise, a tiny camera may be threaded through the catheter to help the surgeon precisely locate the kidney stone, see the needle while it's being placed into the kidney to directly access the stone, and also visualize other work done during the surgery.

Next, the surgeon places a sheath/tube along the passageway. Through this sheath, the surgeon passes specialized surgical tools and breaks up the large kidney stones into smaller pieces that can easily come out through urine. The surgeon may place a nephrostomy tube in the same passage to allow the urine from the kidney to directly drain into a bag worn outside the body during recovery. For complicated cases, the nephrostomy tube can even be good access to the kidney if there are more kidney stones or fragments of it that need to be removed during the recovery period.

Lastly, the removed kidney stones are sent to a clinical laboratory for further testing of their type. By knowing the type of kidney stones that the patient had, the surgeon can suggest ways to prevent the same type of kidney stones in the future.

The overall surgery generally lasts for 3-4 hours.

What to expect after PCNL surgery?

A hospital stay of 1-2 days may be recommended. For 2-4 weeks following the surgery, the patient is recommended to avoid heavy weight lifting and pulling or pushing. The patient can resume work only after about a week.

If drainage tubes are placed in the incision sites to collect extra fluids or blood from the kidney, the patient must watch it afterward for any unusual bleeding. If there is blood in thick lumps in urine or drainage, then immediately head to the emergency department. The patient should also contact the healthcare provider at the emergency center if experiencing significant pain or if developing fever or chills after the surgery- indicating infection. The patient can meet the surgeon again after 4-6 weeks of the surgery for a follow-up.

Various other kidney stone surgeries are also performed at Delhi Urology Hospital. For more information about PCNL and other non-invasive kidney stone surgery in Delhi. Book a visit at Delhi Urology Hospital and consult Dr. Niren Rao, an expert kidney stone surgeon.