PCNL:-Percutaneous Nephrolithotomy

The information contained in this blog is intended to assist you in understanding your proposed
surgery;some of the content may or may not apply to you feel free to discuss any issues and questions
you may have about your surgery with the medical and nursing staff looking after you.

Kidney Stone:A kidney stone is a solid piece of material that forms in the kidney out of substances in the
urine.A stone may stay in the kidney or break loose and travel down the urinary tract.Any stone in the
kidney can block the flow of urine and can cause great pain.

PCNL:PCNL stands for Percutaneous Nephrolithotomy.In this operation,the kidney stone is removed
through a small incision on the back.Then an endoscope(a hollow tube with a light-enhanced
telescope)is inserted into the opening to allow the surgeon to see into the kidney. Small kidney stones
are removed by forceps.Larger stones are then broken by stone fragmentation device so that the small
pieces can be removed easily.All stones will be removed except those which are buried inside the kidney
substance. Sometimes it may necessary to make more than one hole to remove the stones completely,
if it is a staghorn calcus..

Once the stone(s)is removed,a catheter(called a nephrostomy tube)is inserted into the kidney.This tube
will drain urine into a drainage bag and will be stitched to your skin to ensure it remains in place.It will
be removed after 48 to 72 hours.

Why do I need a PCNL?

PCNL is recommended as the treatment of choice in following conditions:-

Two cm or larger renal stones

Large upper ureteric stones

Stones in the lower pole of the kidney which cannot be removed effectively by other techniques like
ureteroscopy or ESWL

Stones in the calyceal diverticulum.

Is anaesthesia required?

Yes,it is commonly done under general anaesthesia, in some special situations it can be done under
spinal anaesthesia.

What is the success rate?

It ranges from 90 to 95%.This actually depends upon the size,number and location of the renal
stones.sometimes complete clearance requires a second procedure after a few days.

What happens after the operation?

How much pain will I have ?After PCNL,there will be some pain but it will be much less as compared to
open surgery & will be further reduced with pain medications.Majority of the patients are pain free
within a week.Afer one week,most are feeling no pain at all.Dont hesitate to ask for pain
medications,because if you are free from pain,you can get back to work or daily routine quickly.

Can I take bath?

Yes,but make sure that you rinse yourself thoroughly as soaps may irritate the area.Dab the operated
area rather than rubbing it.

How much time should I take off from work?

Light walking is encouraged right after the procedure.After 2 weeks,jogging and aerobic exercise is
permitted.Strenuous activity should be avoided for 4 weeks.it is advisable to take off from the work for 2
weeks.

Can you drive the car or bike?

Driving following discharge is best avoided for two weeks.It is sensible to drive only when you feel that
you can cope with traffic conditions and can do an emergency stop.

Length of stay

The usual length of stay is four to five days.However,if there is fever or urine leak then you may have to
stay for a longer durati0n in the hospital & your doctor will discuss this issue with you.

What are the complication?

All urological surgical procedures carry a small risk of post-operative bleeding and wound,chest and
urinary tract infection and PCNL is no exception. You will be monitored for the following risk and treated
promptly if they occur.

Common risks:

Blood in the urine which is also called as haematuria.It is usually temporary and settles in a day or two.

Rare risk:

Retained fragments:sometimes not all the stones are removed and these may need further treatment.

Bleeding requiring transfusion of blood or blood products.In rare instances where it is not settled with
conservative managements,you may require angiography to localize the bleeding followed by
angioembolisation(For which you will be shifted to other hospital having the facility).

Damage to the adjacent organs like lung,bowel,spleen or liver requiring surgical intervention are rare
complications.

Kidney infection requiring further treatment.

Usually there is some leakage of urine after the removal of nephrostomy tube & it settles with in 24-48
hours but in case it is prolonged then,stenting may be required.

Risk of complications are more in case of:

Adults over 60years of age and infants.

The overweight,smokers and heavy drinkers.

Staghorn stones

Previous open surgery in the same kidney.