Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy is a procedure to remove kidney stones from the patient’s body. This is procedure is generally recommended in the following cases:

• Stones that are large or irregularly shaped
• Stones that do not pass on their own
• Stones that have not been broken up by extracorporeal shockwave lithotripsy or ureteroscopy
• Stones that are larger than 2 cm

Yes, as it requires general anesthesia the patient will need to be hospitalised for 2 or 3 days. You may need to take off from the work for a week or so.

The time taken for the procedure is approximately 20 to 45 minutes. The aim is to take out all the stones from the area and leave nothing to pass through the urinary tract.

Even minimally invasive surgery like percutaneous nephrolithotomy may carry risks of :

• Infection
• Bleeding
• The procedure creates a hole in the kidney that usually heals on itself
• Procedure on the abdomen might have a small risk of injury to other nearby organs, such as the bowel, the ureter, the liver, or the bladder.

These minor side effects will disappear as the inflammation comes down.

• Urine tests and blood tests to check if any other infections or problems exist.
• CT scan is done to find where the stones are exactly located in the kidney.

The patient will be given general anesthesia. The surgeon will make a small incision in the back and pass a tube through the bladder and up into the kidney. With the help of an X-ray imaging, he will make a puncture in the kidney and will place a sheath into the kidney and break it into small pieces using a special instrument to remove the stones. A drainage tube is left in the kidney to drain up the urine till the area heals. The incision is either stitched or stapled and is covered with a bandage.

After the procedure, the patient is kept under observation to monitor the blood pressure, pulse, and breathing. During the hospital stay, the patient will be given

• Medications for pain
• Antibiotics to prevent infections
• Compression stocking to prevent blood clots
• X-ray is taken to check if any stone fragments are left
• Removal of drainage tube is done after 48 hours of the procedure.

Advantages of this surgery are:

• It is the most effective technique for making sure a patient is stone-free.
• It is less invasive than a full open surgery to treat kidney stones because it is among the more difficult surgeries, the surgery is performed by surgeons with specialized training. Urologists and radiologists will work together on these surgeries.