What is it?
Percutaneous Nephrolithotomy (PCNL) is the
preferred technique for treating large stones (over 2cm in diameter) within the
kidney. It involves keyhole surgery performed through a 1cm incision in the
skin overlying the kidney.
What are the advantages?
Allows large or complicated stones to be
treated in a minimally invasive fashion, where in the past this would have
necessitated a large skin incision.
Hospital stay is 3-4 days, and out of
hospital recovery time is significantly shorter than traditional open surgery.
What are the disadvantages?
Compared to traditional treatments of large
complex stones, there are no disadvantages. Improved techniques and equipment
have allowed this type of surgery to be safer than ever before.
What preparation is required?
You will be required to have detailed imaging
to allow the surgeon to assess the stone in fine detail regarding its
relationship to the kidney and nearby structures. This will enable the surgeon
to plan the best access point(s) to the kidney to allow effective clearance of
stones.
As the procedure is performed under general
anaesthesia, you should have nothing to eat or drink for 6 hours prior to
treatment. Regular medications can be taken with a sip of water with the
exception of blood thinning agents (eg. warfarin, aspirin,
clopidogrel) or non-steroidal anti-inflammatories which need to be stopped for
7-10 days. A mid stream urine (MSU) test is required to ensure the urine is
sterile before treatment is undertaken. Other tests required include urine
culture, kidney function studies, and complete blood counts. These tests will
all be organized from the rooms after your consultation.
What are the risks?
This form of surgery is low risk if performed by an
urologist who is specifically trained in this technique, and aided by
meticulous pre-operative planning. The specific risks are uncommon but
include infection, excessive bleeding (necessitating blood transfusion 2%,
embolisation 1%, renal exploration 0.5%), and adjacent organ injury (spleen,
liver, bowel, and lung).
What do I need to bring to surgery?
All related available imaging such as KUB (kidneys,
ureter, and bladder) x-ray, CT scan abdomen, or kidney ultrasound
Your usual medications
What happens in the operating room?
The operation is performed under a general anaesthetic
and lasts approximately 2 to 3 hours. It is a team effort requiring
coordination between surgeon, anaesthetist, radiology and nursing staff. You will
be positioned on the operating room table lying on your front “stomach” for the
duration of the surgery. The procedure is accomplished with the assistance of
x-ray imaging to guide entry of a 1cm tube into the kidney. This provides
access into the kidney drainage system allowing telescopes and instruments to
visualize, fragment and remove stones. A drainage catheter (nephrostomy tube)
which exits through the skin is left in the kidney at the end of the procedure.
What to expect afterwards?
You will have a temporary catheter called a nephrostomy
tube draining the kidney, as well as a urinary catheter in-situ. They will be
removed prior to discharge from hospital. The urine will be bloodstained for up
to a week after discharge from hospital. Imaging is performed immediately after
surgery to assess stone clearance. Occasionally, further minor surgery is
required to clear any remaining stones to achieve complete stone clearance.
Your hospital stay will be 3-4 days on average.
Follow-up
You
will be required to take it easy during the recovery phase for several weeks.
There should only be minimal discomfort from the wound. Oral antibiotics will
be given for a further five days to prevent infection. It is important to
inform us if you feel unwell with fevers, chills, or develop heavy bleeding in
the urine. Your initial follow-up will be in 6 weeks after discharge.
Occasionally, a urinary stent is left to ensure the urine drains correctly into
the bladder. This will require removal at a later time
