Title: Minimally Invasive (PCNL) Surgeries for Kidney stone Percutaneous Nephrolithotomy
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Percutaneous Nephrolithotomy Percutaneous
Nephrolithotomy is the surgery used to perform to
treat medium to large kidney stones. Kidney stone
has another name in medical industry, as renal
calculi. The stones are made by solidification
from the deposits of calcium salts that are
highly concentrated, especially when found with
the kidneys. These kidneys stay for some time
inside the kidney and may start moving down
through the urinary tract. The size of the kidney
varies in size. Small stones are usually passed
out from the body with no pain or causing a
little pain. But the larger stones are stuck in
the urinary tract and it blocks the urine flow.
When the urine is stopped in such way, bleeding
or severe pain is occurred.
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Purpose The purpose of PCNL is the removal of
renal calculi in order to relieve pain, bleeding
into or obstruction of the urinary tract, and/or
urinary tract infections resulting from
blockages. Kidney stones range in size from
microscopic groups of crystals to objects as
large as golf balls. Most calculi, however, pass
through the urinary tract without causing
problems. Renal calculi are formed when the
urine becomes supersaturated (overloaded) with
mineral compounds that can form stones. This
supersaturation may occur because the patient has
low urinary output, is excreting too much salt,
or has very acid urine. Urolithiasis is the
medical term for the formation of kidney stones
the word is also sometimes used to refer to
disease conditions associated with kidney stones.
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How is the Percutaneous nephrolithotomy (PCNL )
Surgery performed? While you are under the
general anaesthetic the surgeon will examine your
bladder with a long, thin, semi-rigid or flexible
telescope and pass a small tube up to your
kidney, which has the stone. This is used to pass
a mixture of a coloured dye and x-ray dye to the
kidney making it easier to see during the
operation. You will then be placed face down on
the operating table and the consultant will make
one or more small incisions into your back. This
is done using special metal or balloon dilators
(see diagram). This enables the consultant to
pass a telescope into your kidney. The stone or
stones in the kidney are then removed either
intact or in pieces after breaking them with
special instruments. X-rays will be taken during
and at the end of the procedure to ensure that
all accessible bits of the stone have been
removed from your kidney. A telescope is passed
down into the kidney so that the surgeon can see
the stone. The stone is broken up and then the
pieces are removed using a special instrument.
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Why is Percutaneous Nephrolithotomy
(PCNL) Necessary? You have been diagnosed as
having a kidney stone (or stones) causing some,
or all, of these symptoms pain, infections,
bleeding or obstruction of your kidney, which if
left untreated, may lead to further symptoms or
complications, such as severe infection or loss
of kidney function. This operation (PCNL) is
performed to remove large kidney stones using a
keyhole approach. This is a major operation
despite the term keyhole surgery. The procedure
requires a general anaesthetic and may last 1 to
3 hours with a hospital stay from 4 to 7 days.
The success rate of kidney stone clearance ranges
from 75 to 100 depending on various factors.
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- What can I expect after the Percutaneous
Nephrolithotomy (PCNL)? - There will be a catheter in your bladder to
drain your urine. Your urine may be coloured with
blood or bluish-green dye used during the
procedure. The catheter will be removed once you
are up and about or when the consultants are
satisfied with your progress. - There will be a tube in your back connected to
a drainage bag to allow the kidney to drain a
mixture of blood and urine. The blood in this
tube will gradually clear in a day or two.
Occasionally further x-rays may be necessary
before this tube is removed. Removing the tube
does not usually require any painkillers or
sedation. - There will be a drip in one or both of your
arms to give intravenous fluids until you are
able to drink and eat normally. This may
sometimes be used to give a blood transfusion if
required. - You may be given antibiotics post-operatively
either orally or through the drip in your arm. - You will be prescribed and given appropriate
painkillers after the procedure.
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- What are the Advantages Percutaneous
Nephrolithotomy (PCNL)Surgery? - Complicated or larger stones are allowed to be
treated in minimally invasive method, unlike the
past methods, which demanded larger incisions
over the skin. - PCNL is considered to be an effective
procedure, as it achieves better results and
stone-free outcomes. - The pain medication required for the surgery
would be half of the usual pain medication
requirement, for many of the patients. - Stay in hospital would be decreased to 3 to 4
days. Even the recovery time, out of the hospital
is also much reduced than the traditional open
surgery treatment.
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