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.
- The surgical process involves minimally invasive method to remove the complicated or large stones, unlike the previous cases, where larger skin incision had to be done.
- Shorter stay in the hospital
- Less complications
- There would no pain
- No cuts are required to be done
Need for the Surgery
Small stones can be removed from litotriptor or shock wave machine, but it cannot remove the larger stones and so PCNL stands to be an effective alternative to remove the larger stones, as it uses operating telescope, from the kidney. Usually surgical treatments are required, when the stone is very hard difficult to view through x-rays.
Before the Procedure
Present and past medical conditions of the patient are discussed with the patients, by the surgeon and the team. It is important that the patient stops eating or drinking, before 6 hours of the surgery. Special medications, like non-steroidal anti-inflammatories and blood thinning agents must be stopped before 10 days of duration. Special tests, like MSU or mid stream urine test, kidney function, urine culture and some other complete blood count tests are conducted prior to the surgery.
The patient is given either general anesthesia or spinal anesthesia, based on the requirement. The surgery is performed, making 1 cm incision into the overlying kidney skin. It makes use of nephroscope to be passed in the skin, through the track from the back of the patient. Either a laser probe or ultrasonic methods are used for breaking the kidney stones. After the stones are broken up, these are suctioned out.
In nephrolithotripsy or nephrolithotomy, a small incision is done on the back of the patient. A small hollow tube is then passed to the kidney and also a probe through the tube is given so that the stones can be removed from the kidney. In the process of nephrolithotomy, stones are removed through the tube. When it is done in nephrolithotripsy, the stones are broken and the small fragments are removed through the tube. Both the procedures relieve the patient from bleeding, obstruct of the tract and relieve the pain. It is an effective procedure to reduce or relieve from the urinary tract infections that usually result in blockages.
- 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.
- Excessive bleeding
- Injury to adjacent organs, like bowel, liver, lung or spleen
The recovery time is much lesser, as the minimally invasive technique is employed to perform the procedure.
Cost of Percutaneous Nephrolithotomy (PCNL)
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