Last week I wrote about two common surgeries: Lithotripsy and Ureteroscopy. Today, we discuss a third type of surgery, PCNL, and why and how it is done.
What is PCNL?
PCNL stands for Percutaneous Nephrolithotomy. It’s a minimally invasive surgical procedure used to remove kidney stones. This method involves making a small incision in the back to access the kidney, allowing the surgeon to remove the stones effectively.
Why Would a Patient Require PCNL?
Patients may require PCNL for several reasons, primarily related to the size, type, and location of the kidney stones:
Stone Size
- PCNL is typically recommended for large kidney stones, usually greater than 2 centimeters in diameter.
- Stones of this size are often too large to be passed naturally or treated effectively with other less invasive methods like shock wave lithotripsy (SWL) or ureteroscopy.
Stone Type
- Certain types of stones, such as cystine, struvite (infection), or calcium oxalate, can be large and hard, making them more challenging to treat with other methods.
- Staghorn calculi, a type of stone that takes on the shape of the kidney’s internal structures, often requires PCNL for complete removal due to its complexity and size.
Complex Stone Location
- Stones located in parts of the kidney that are difficult to reach through non-surgical means, such as within the renal pelvis or branching into the kidney’s calyces, might necessitate PCNL.
Other Treatments Failed
- Patients who have not had success with other treatments like SWL (shockwave lithotripsy) or ureteroscopy might be advised to undergo PCNL.
- Recurring or multiple stones that are not treatable through less invasive methods may also require PCNL.
How is PCNL Performed?
The PCNL procedure involves several steps:
Preoperative Preparation
- Patients undergo imaging tests like CT scans or X-rays to locate the stones precisely.
- General anesthesia ensures the patient is comfortable and pain-free during the procedure.
Access to the Kidney
- A small incision (about 1 cm) is made in the patient’s back to create a direct pathway to the kidney.
- A nephroscope, a specialized instrument with a camera and tools, is inserted through this incision.
Stone Removal
- Using the nephroscope, the surgeon locates the kidney stones.
- The stones are then broken into smaller pieces using ultrasound, laser, or pneumatic energy.
- The fragments are removed through the nephroscope, and any remaining pieces are washed out.
Postoperative Care
- A temporary tube (nephrostomy tube) may be left in place to drain urine and ensure proper healing.
- The patient typically stays in the hospital for 1-2 days for monitoring and recovery.
Recovery and Benefits of PCNL
Recovery
- Most patients can resume normal activities within 1-2 weeks post-surgery, with some restrictions on strenuous activities.
- Pain and discomfort are usually manageable with prescribed medications.
Benefits
- PCNL offers a high success rate for removing large and complex stones.
- It minimizes the need for multiple procedures, reducing treatment time and discomfort.
Kidney Stone Prevention
Preventing new stones is key to avoiding surgery, stents, and suffering. Take my self-guided Kidney Stone Prevention Video Course and get the education you need to lower your stone risk. You won’t regret it—guaranteed!
Your friend and advocate,
Jill
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