Percutaneous nephrolithotomy (PCNL) is a preferred treatment for large stones within the kidney or upper ureter. The procedure involves making a small incision (1 cm) in the back overlying the location of the kidney. A tunnel is then created from the skin into the kidney to allow passage of a nephroscope. The nephroscope is used to locate the existing stone and any small stones that may not have been visible by X-ray. The nephroscope has an inner channel that allows passage of instruments that are used to break up the stone.
Percutaneous nephrolithotomy (PCNL) provides the urologist with an important treatment option for patients with : -
- Stones located in the kidney
- Stones accompanied by urinary tract anomaly
- Stones in locations that preclude effective ESWL or endoscopic retrieval
A wide variety of instrumentation is required for percutaneous nephrolithotomy. Each case will present unique challenges. It is imperative that instrumentation is properly selected to match the requirements of the case.
A selection of Boston Scientific instruments can be used for percutaneous access to the urinary tract for stone retrieval and the establishment of nephrostomy drainage.
The following phases in a PCNL procedure can be identified : -
- Access: guidewire
- Dilatation: balloons and access sheaths
- Retrieval: baskets, lithotripsy devices
- Drainage: catheters
In percutaneous nephrolithotomy or nephrolithotripsy, the surgeon makes a small incision in your back to remove kidney stones. He or she then puts a hollow tube into your kidney and a probe through the tube. In nephrolithotomy, the surgeon removes the stone through the tube. In nephrolithotripsy, he or she breaks the stone up and then removes the fragments of the stone through the tube. You need either general anesthesia or regional or spinal anesthesia during this procedure. A small tube (catheter) inserted into the kidney will drain urine until the kidney heals.
What To Expect After Treatment ?
You will be in the hospital for at least 2 to 3 days. Most people are able to return to work within a few weeks.
Risks of this procedure include : -
- Holes (perforation) in the kidney. They usually heal without further treatment.
- Injury to other abdominal organs, such as the bladder or colon.
- Damage that affects normal kidney function.
The following complications may take place : -
- Injury to the colon
- Injury to the renal blood vessels
- Urinary leak may persist for few days
What To Think About ?
These procedures are technically difficult. A stone that has left the kidney may need to be pushed back into the kidney with a small tool (ureteroscope) before the surgeon can do the procedure.
These procedures are used more frequently than extracorporeal shock wave lithotripsy (ESWL) to remove larger stones, such as staghorn calculi. Every fragment of a staghorn calculus must be removed to prevent the stone from returning.
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