Definition and Overview
Percutaneous nephrolithotripsy is a safe procedure that removes kidneys stones by blasting them into smaller fragments before they are suctioned.
The kidneys are part of the urinary system found on each of the lower sides of the body. They are connected to the ureter and their main task is to remove toxic wastes and other by-products in the body.
In certain cases, the organs develop kidney stones, the most common of which are calcium stones, which form due to high levels of calcium oxalate in the urine. Other types include struvite stones, which are due to an infection that attacks the urinary track, and uric acid stones, which are the result of other conditions such as gout or a high protein diet. Regardless of the type, these stones can cause different health problems, such as the following:
- Chronic and excruciating pain, especially in the lower back. The pain can be so debilitating that it can significantly reduce a person’s quality of life.
- Obstruct the flow of urine if the stones are lodged in the tube connected to the ureter or bladder
- Kidney damage (in extreme cases)
The kind of treatment for kidney stones usually depends on their sizes. If they are less than one centimeter, they can be removed through ureteroscopy or shockwave lithotripsy. In ureteroscopy, a flexible tube with a camera is inserted into the ureter then into the kidney to locate the kidney stone. A laser fiber is then used to break up the stone, after which the fragments are allowed to pass through the body as urine or they are extracted. In shockwave lithotripsy, shockwaves are used outside the body to destroy the stones.
For large kidney stones, percutaneous nephrolithotripsy is often the first form of treatment.
Who Should Undergo and Expected Results
Percutaneous nephrolithotripsy is ideal for patients with kidney stones that are more than 2 centimeters. It is also considered if the patient has several kidney stones or they are too dense. Usually, these types of stones can no longer be removed by natural means—that is, through urine. They may also cause more obvious symptoms such as blood in the urine and flank pain.
The procedure is also performed if the kidney stones are already causing obstruction especially in the ureter and if other types of treatment fail to correct the condition.
How Does the Procedure Work?
Prior to the kidney stone removal, the patient goes through at least one consultation with the surgeon during which the surgeon can request a series of tests to determine if the patient is an ideal candidate for the procedure.
The patient will then be advised to fast a day before surgery and to stop taking certain medications at least a week before the procedure.
To surgery is performed under general anaesthesia and the patient’s heart rate and blood pressure are monitored by an anaesthesiologist all throughout the procedure. The patient lies down on the operating table with his back exposed. An incision of at least a centimeter is then made to insert a tube. A probe is then used to create a visual guide for the surgeon while a contrast dye is introduced to map the parts of the kidneys and reveal the exact location of the stones. The stones are either suctioned through a tube, in a procedure known as nephrolithomy, or broken down into fragments before they are removed.
The entire procedure may take 1 to 2 hours and typically requires up to 2 days of hospital stay.
Possible Risks and Complications
This type of kidney stone removal procedure has more pronounced risks and complications than other forms of treatment. For example, ureteroscopy and shockwave lithotripsy often do not require any hospitalisation, and patients can get back to their regular activities within 3 to 8 days. Recovery period for percutaneous lithotripsy takes between one to two weeks.
Other possible risks and complications may include:
- Damage to nearby organs including the bladder, colon and adrenal glands
- Injury to blood vessels of the kidneys, which can lead to kidney malfunction
- Internal bleeding
Infection at the wound site, which can cause a life-threatening systemic inflammation called sepsis
Over the years kidney stone removal has greatly improved, so these risks and complications are significantly minimised. Also, in the majority of cases, the benefits of percutaneous nephrolithotripsy outweigh the risks, as there is a very high chance that all stones will be removed.
Preminger GM, Assimos DG, Lingeman JE, Nakada SY, Pearle MS, Wolf JS, Jr, et al. Chapter 1: AUA guideline on management of staghorn calculi: diagnosis and treatment recommendations. J Urol. 2005;173:1991–2000.
Fernstrom I, Johansson B. Percutaneous pyelolithotomy: A new extraction technique. Scand J UrolNephrol. 1976;10:257–9. [PubMed]
**Title: Percutaneous Nephrolithotripsy: Overview, Benefits, and Expected Results**
Percutaneous nephrolithotripsy (PCNL) is a minimally invasive surgical procedure used to remove large kidney stones or those that cannot be effectively treated using other treatment options. In this article, we will explore the overview, benefits, and expected results of percutaneous nephrolithotripsy. Whether you are a potential patient or a healthcare professional, this comprehensive guide will provide valuable insights into this procedure.
Percutaneous nephrolithotripsy, also known as percutaneous nephrolithotomy (PCNL), is a surgical procedure that involves making a small incision in the back to access the kidney and remove large or complex kidney stones. It is usually performed under general or spinal anesthesia, and imaging techniques such as fluoroscopy or ultrasonography are used to guide the surgeon during the procedure.
The primary goal of PCNL is to fragment the kidney stones into smaller pieces and remove them using specialized tools. This surgical approach is suitable for stones that are larger than 2 cm in size, located in the kidney, pelvis, or upper ureter, and those that have not responded to non-invasive treatments like extracorporeal shockwave lithotripsy (ESWL) or ureteroscopy.
**Benefits of Percutaneous Nephrolithotripsy**
Percutaneous nephrolithotripsy offers several benefits for patients with large kidney stones that cannot be treated with other conservative methods. Some of these benefits include:
1. **High Success Rate:** PCNL has a high success rate in removing large kidney stones, often achieving stone clearance rates above 90%. The procedure effectively fragments and removes even complex stones, resulting in long-term relief for patients.
2. **Minimally Invasive:** Despite being a surgical procedure, PCNL is considered minimally invasive compared to open surgery. It involves a small incision, usually just 1 cm, reducing the potential risks and complications associated with larger incisions.
3. **Complete Stone Clearance:** PCNL allows for complete removal of large stones, minimizing the chances of stone recurrence or residual fragments. This comprehensive stone clearance improves the patient’s quality of life and reduces the need for additional interventions.
4. **Faster Recovery:** Compared to open surgery, PCNL enables a faster recovery. Most patients can expect to be discharged within a few days after the procedure and can resume their daily activities within a few weeks, depending on the size and complexity of the stone.
5. **Reduced Pain:** PCNL offers excellent pain control due to the use of anesthesia during the procedure. In addition, advancements in pain management techniques have further improved patient comfort and satisfaction.
**Expected Results of Percutaneous Nephrolithotripsy**
Percutaneous nephrolithotripsy can yield positive outcomes for patients dealing with large kidney stones. However, the specific results may vary depending on individual factors such as stone composition, size, and location. Some expected outcomes of PCNL include:
1. **Stone Removal:** The primary objective of PCNL is to completely remove the kidney stones. The surgeon will use specialized instruments, such as a nephroscope, to fragment the stones and remove them using suction or graspers. The success rate of stone removal is typically high, with very few cases requiring additional procedures.
2. **Symptom Relief:** PCNL provides effective relief from symptoms associated with kidney stones, such as severe pain, recurrent urinary tract infections, hematuria (blood in urine), and hydronephrosis (kidney swelling). Removal of the stones can alleviate these symptoms and prevent complications.
3. **Improved Kidney Function:** Large kidney stones can impair kidney function over time. PCNL aims to restore kidney function by removing the stones and allowing the kidneys to resume normal functioning. This can prevent kidney damage and improve overall renal health.
4. **Lower Stone Recurrence:** PCNL offers a lower rate of stone recurrence compared to non-invasive treatments like ESWL or ureteroscopy. The complete removal of stones during PCNL reduces the chances of residual fragments or recurrent stone formation, enhancing the long-term success of the procedure.
Percutaneous nephrolithotripsy (PCNL) is a valuable surgical technique for the removal of large and complex kidney stones. Its minimally invasive nature, high success rates, and comprehensive stone clearance make it a favorable treatment option. The procedure offers patients relief from symptoms, restores kidney function, and reduces the risk of stone recurrence. If you have been struggling with kidney stones that have not responded to non-invasive treatments, PCNL may provide the solution you need to overcome this condition and improve your quality of life. Consult with a healthcare professional to determine if you are a suitable candidate for percutaneous nephrolithotripsy.