Percutaneous nephrolithotomy (PCNL) in Iran
Percutaneous nephrolithotomy (PCNL) in Iran | Performed by the best Iranian Urologists
GOALS
- To ensure complete stone clearance with minimal morbidity
PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN IRAN: ALL YOU NEED TO KNOW
PCNL is considered as one of the most common treatment methods for renal calculi (kidney stones). It was first innovated in the 80s and accordingly has evolved a lot since then. Along with the introduction of newer techniques such as extracorporeal shockwave lithotripsy, the renal treatment indications have changed gradually.
Before then large stones were treated with PCNL and accordingly ESWL was applied for smaller ones. Energy and optics improved technically over the years, as a result, miniaturization of surgical instruments has led to using the PCNL for even smaller stones with better clearance rates and lower morbidity.
This procedure involves entering a nephroscope into the kidney through an incision in the back. If the stone is removed intact, it is called nephrolithotomy. If the stone is broken to pieces and then is removed it is called nephrolithotripsy in which a high-frequency sound wave is used to break the stone and a suction machine is used to vacuum the dust.
The words in the phrase mean:
• Percutaneous: From the skin
• Nephrolithotomy: A combination of three-word roots nephron- (kidney), litho-(stone) and -tomy (removal)
• Nephrolithotripsy: A combination of three-word roots nephron- (kidney), litho (stone), and -trips (crushed)
The rate of stone clearance is about 95% by PCNL.
What are the causes of percutaneous nephrolithotomy (PCNL)?
This procedure is applicable for treatment of these conditions:
• Large stones (bigger than 2 cm)
• Irregular and diverticular stones
• Stones that aren’t broken enough with ESWL
• Staghorn or partially staghorn stones (these stones block more than one unit of collecting system)
• The location of the stone is hard to reach through other methods (lower pole)
• The stones hasn’t responded to other methods
What are preparations for percutaneous nephrolithotomy (PCNL)?
Before you undergo PCNL, your blood and urine will be tested for contractions including pregnancy, blood disorders, and uncontrolled infections. Then, the stones are located using ultrasound, computerized tomography (CT) scan and X-ray images. The images are analyzed to determine the locations and number of the punctures and to predict the surgery stages.
Your doctor may give you instructions on:
• The time to stop taking certain medications such as blood thinners.
• Time of last urinating before the procedure
• To take pain killers after the procedure
• To avoid eating, drinking and smoking 6 to 8 hours before the operation for reducing the anesthesia complications
• To take antibiotics after the procedure to reduce the risk of infections
• To arrange for someone to give you a ride home after hospital discharge
What are the common risks of PCNL?
This operation is minimally invasive and has proven to be safe but it may carry some potential risks just like any other surgery including:
• Bleeding: you may lose blood in the procedure but it rarely results in having a blood transfusion.
• Infection: you will be treated with broad-spectrum antibiotics to reduce the risk of infections. However, if you notice any sign of an infection including infectious discharge from the incision site, fever and bleeding contact your doctor.
• Abdominal organ damage: Most of the abdominal surgeries pose a small risk of injuring nearby organs. In PCNL, the liver, spleen, pancreas, gallbladder, bowel and blood vessels may be damaged however it is rare.
• Conversion of PCNL to open surgery: If the surgeon faces difficulty during the procedure, he/she may convert it to open surgery. The open surgery results in a larger incision and a longer recovery time.
• Second surgery: If the surgeon can’t remove the stones in the first operation due to the size or location of the stone, another surgery is needed.
What can we expect from percutaneous nephrolithotomy (PCNL)?
PCNL is performed under general anesthesia in a hospital. In this situation, you are asleep and don’t feel any pain. The surgeon usually follows the following steps:
• A drainage catheter is placed in the bladder to void it.
• Another catheter is placed in the ureter to infuse contrast or dye to locate the stones along with ultrasound and X-rays.
• A small incision (1cm) is made in the flank (back) to access the blocked collecting system unit using a tube and guidewires.
• A nephroscope is inserted into the tube to view inside of the kidney.
• The stones are removed using a grasper.
• If the stones can’t be removed directly, the surgeon uses laser or sound energy to break them.
• The broken pieces are removed and the dust is suctioned out.
• The surgeon injects contrast material to the kidney to confirm the complete removal of the stones. If the contrast passes through the bladder, it indicates that the blockage is removed.
• The surgeon may place temporary JJ-stents in the kidney to prevent the blockage of the ureter due to swelling. It will be removed before your discharge.
• A drainage catheter (nephrostomy) may be put at the incision site to drain the blood and urine directly from the kidney. It will be removed several days after your discharge.
Complicated surgery takes about 3 to 4 hours.
Percutaneous nephrolithotomy (PCNL) FAQs
1. How long does healing take time?
The duration of your hospital stay is around 3 days. As soon as you will be able to void means your bladder is sufficiently working and have no fever and severe pain, you will be discharged. You should avoid strenuous activities for two weeks and you can return to work after one week.
2. What are the recommendations for a better recovery?
• Drink 1.5 liters of water throughout the day to help the small stone fragments pass with urine flow. Include more vegetables and exclude meat to reduce the need to squeeze for defecating which leads to faster healing
• Rest for a week after your operation and avoid heavy activities for two weeks
3. Is this surgery painful?
Because in this operation your kidney is punctured and instruments are inserted into your urinary system, you may experience some of these symptoms for several weeks:
• Burning sensation and discomfort when urinating
• The small amount of blood in the urine
• Urinating more frequently and urgently
• Pain due to internal abrasions that heal gradually and temporary blood clots
If the pain persists despite taking prescribed medicines, you should contact your doctor very soon.
4. Who is not a good candidate for this operation?
If you have severe cardiac or pulmonary conditions and have an unfixable blood disorder, PCNL is not an option for you. Also, urinary infections should be cleared before the surgery to reduce the risk of sepsis during operation.
5. Is it possible to perform the surgery for both kidneys at the same time?
Yes. You and your surgeon will decide the kind of surgery. You can have bilateral PCNL that is performed at the same stings or you can set two dates for two surgeries.
6. What should I do if I am suspected to be at high risk of forming new stones?
If the results show that you are susceptible to forming new stones, your doctor will order a series of blood and urine tests known as metabolic evaluation to determine the cause of stone formation. Then you will be recommended to take some preventive measures including changing your lifestyle (diet and exercise) and taking prescribed medications that generally have no side effects.
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