Kidney Stone Removal - PCNL

What are kidney stones?

Kidney stones are hard deposits made of minerals and salts that form inside your kidneys. They can vary in size and may cause severe pain, blood in the urine, and difficulty passing urine. If stones are too large or complex to pass naturally, Percutaneous nephrolithotomy (PCNL) is one of the most effective surgical treatments to remove them.

What is percutaneous nephrolithotomy (PCNL)?

Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large or difficult-to-reach kidney stones. It is usually recommended for stones larger than 2cm or stones that cannot be treated effectively with other methods. During PCNL, a small incision is made in your back to access and remove the stones using specialised instruments.

When is PCNL recommended?

Your doctor may recommend PCNL surgery if:

• The kidney stones are too large for less invasive treatments like shockwave lithotripsy (SWL).
• Stones are blocking urine flow, causing pain, recurring infections, or kidney damage.
• There are multiple large stones or stones in complex areas of the kidney.
• Previous treatments for kidney stones were unsuccessful.
• You have anatomical abnormalities that make other treatments less effective.

PCNL is particularly beneficial because it can often remove larger stones in a single session, reducing the need for multiple treatments.

Preparing for PCNL

Before surgery, you will have a consultation with a urologist to discuss the procedure and any potential risks. Tests such as blood tests, ultrasounds, or CT scans will determine the size, location, and number of stones.

Key preparation steps include:

• Fasting for several hours before the procedure.
• Informing your surgical team about any medications you take, especially blood thinners or anti-inflammatory drugs, as these may need to be stopped temporarily.
• Undergoing additional assessments if you have conditions like diabetes or heart disease to ensure you are fit for surgery.

What happens during PCNL?

PCNL is performed under general anaesthesia, so you will be asleep throughout the surgery. Here’s what to expect:

• The surgeon makes a small incision in your back to access the kidney.
• Using imaging guidance (ultrasound or X-rays), a tube (nephroscope) is inserted into the kidney.
• The stones are broken into smaller fragments using specialised tools, and the pieces are removed through the tube.
• In some cases, a stent may be placed in the ureter (the tube connecting the kidney to the bladder) to ensure proper urine drainage.
• A drainage tube (nephrostomy tube) may also be temporarily placed to allow fluid to drain from the kidney.

The surgery typically takes 1 to 3 hours, depending on the size and complexity of the stones.

What are the benefits of PCNL?

• Highly effective: Removes large and complex kidney stones in a single procedure.
• Minimally invasive: Involves a small incision, resulting in less pain and quicker recovery compared to open surgery.
• Improved kidney function: Relieves blockages, infections, or damage caused by kidney stones.
• Symptom relief: Eliminates pain, difficulty urinating, and other symptoms associated with kidney stones.

What are the potential risks and complications?

While PCNL is generally safe, there are some risks:

• Bleeding: Rarely, a blood transfusion may be needed.
• Infection: Antibiotics may be prescribed to prevent or treat infections.
• Injury to surrounding organs: Although rare, nearby structures like the bowel can be affected.
• Stone fragments: Small pieces of the stone may remain and require further treatment.
• Fluid leakage: Temporary leakage from the kidney may occur.
• Kidney damage: Rarely, the treated kidney may lose some function.

Your surgeon will discuss these risks with you before the procedure and explain how complications can be minimised.

Recovery after PCNL

Most patients stay in the hospital for 1 to 2 days after PCNL for monitoring. You may experience mild soreness around the incision site, and it is normal to notice some blood in your urine for a few days.

To ensure a smooth recovery:

• Rest and avoid strenuous activities or heavy lifting for 1 to 2 weeks.
• Take prescribed pain relief to manage discomfort.
• Stay hydrated to help flush out any remaining stone fragments.
• Wear loose, comfortable clothing to avoid irritation around the incision site.

Light activities, such as walking, are encouraged to aid recovery and prevent complications like blood clots.

Long-term outcomes

PCNL is highly effective at removing kidney stones and providing relief from symptoms. Most patients feel a significant improvement in their overall comfort and quality of life.

To reduce the risk of future kidney stones:

• Drink plenty of water to stay hydrated.
• Adjust your diet to limit foods high in salt or oxalates.
• Follow your doctor’s advice about medications that regulate mineral levels in the urine.

Your surgeon will schedule a follow-up appointment to monitor your recovery and ensure the stones have been completely removed.

PCNL offers a reliable and efficient solution for managing large or complex kidney stones, allowing you to return to your normal activities free from discomfort.