Percutaneous Nephrolithotomy (PCNL)
Percutaneous nephrolithotomy (PCNL) is a surgical procedure to remove kidney stones that are too large to transit typically. Due to the crystallization of chemical compounds in the urine, kidney stones form in the urinary tract. Percutaneous nephrolithotomy (PCNL) is typically recommended when other methods to pass a kidney stone are ineffectual or impossible.
The term "percutaneous" indicates that the procedure is performed via the epidermis. The term "nephrolithotomy" refers to the excision of a calculus (kidney stone) from a kidney.
Why is it done?
Percutaneous nephrolithotomy is often advised when:
- Large kidney stones obstruct more than one branch of the kidney's collecting system. These are known as staghorn kidney stones.
- Kidney stones are more significant than 0.2 centimetres (0.8 inches) in diameter.
- The ureter connecting the kidney to the bladder contains large stones.
- Alternative treatments have failed.
This procedure has been performed on many patients over the last several years and is the accepted standard of care for patients with large, very firm, or resistant kidney stones. As a result, it has replaced traditional kidney stone operations for most patients.
Surgical procedures typically last between three and four hours. To conduct the surgery, a 1 cm incision is made in the back or side of the patient. A catheter is inserted into the kidney through the incision under x-ray guidance. The stone is broken up and discarded. Before the stone can be extracted, a laser or a lithotripter may be used to split it up, if necessary. Compared to open stone surgery, this procedure has resulted in substantially less post-operative pain, shorter hospital stays, and an earlier return to work and daily activities. This method has a higher success rate for removing all stones in a single session than other methods, such as extracorporeal shock wave lithotripsy (ESWL), which frequently requires multiple attempts.
Risks and complications
Although this procedure has been demonstrated to be highly safe, as with any surgical procedure, there are potential risks and complications. The rates of safety and complications are comparable to those of open surgery. Possible dangers include:
- Blood loss: There will be some blood loss during this procedure, but patients rarely require a blood transfusion.
- Infection: Antibiotics with a broad spectrum are administered to all patients to reduce disease risk after surgery.
- Tissue/Organ Damage: Although uncommon, damage to adjacent tissue/organs such as the intestine, vascular structures, spleen, liver, lung, pancreas, and gallbladder may necessitate additional surgery. Loss of kidney function is uncommon but a possible risk. Additionally, scar tissue may form in the kidney or ureter, necessitating further surgery.
- Conversion to open surgery: If complications arise during this surgical procedure, it may be necessary to convert to an available operation. This may necessitate a larger standard open incision and a prolonged recuperation period.
- Failure to Remove the Stone: It is possible that the stone(s) cannot be removed entirely, typically due to the size or location of the stone(s). Additional care may be necessary.