OPD-Journey

Kidney stones are frequently diagnosed these days. Patients present to us with complains of flank pain, fever or urinary problems. When the stone size is more than 10 mm, it requires surgical treatment. Large stones more than 25 mm were earlier removed with open surgery but with the advancement in tecnology, the same is being done with key hole surgery. The process of removing kidney stone with key hole endoscopy is called Percutaneous Nephro-lithotomy( PCNL). It is an inpatient invasive procedure in which the surgeon removes the kidney stone(s) through a small incision in the skin. Traditionally, PCNL was used to remove stones larger than 2 cm or irregularly shaped stones, but with the advancements and minitiarization of instruments, a smaller hole procedure ( Miniperc) is done to treat stones between 10-20 mm.

Precision Urology hospital is a centre of excellence in managing kidney stones. Almost all variants of the PCNL technique are being offered to patients with appropriate indications including Prone PCNL, Supine PCNL, Tubeless PCNL, Totally Tubeless PCNL, Supra costal PCNL, Miniperc, Multi- Miniperc, Multiple tracts PCNL, Multi stage PCNL for complex stones and Endoscopic combined intar renal surgery ( ECIRS). The following section describes a simple Prone position PCNL technique in an index patient ( adult patient with normal renal anatomy without infection).

• How is a PCNL performed?

  PCNL involves the following steps:

  1. Patient is called nil orally on the day of surgery. ( Patient previously has been thoroughly checked pre operatively and investigated by the consultant).
  2. Patient is given spinal anaesthesia.
  3. In dorsal lithotomy position,Urologist inserts a cystoscope (a telescope-like instrument which is a thin tube with a camera and light on the end) to inspect the urinary bladder.
  4. He inserts a tube (catheter) into the ureter to your kidney and injects a special dye through the tube which travels to the kidneys. This radio-opaque dye highlights the kidney stones on an X-ray.
  5. Once the stone is located by X-ray, the urologist makes a 1 cm incision on your back, and through it, he accesses the kidney with an x-ray guided fine needle.
  6. With the help of a guide wire, the urologist serially inserts increasing sizes of dilators up to 1 cm to create an access passage to your kidney.
  7. Once the passage is created, the urologist inserts a hollow tube through which a nephroscope targeting the stones is inserted. Stone is then fragmented with lithoclast/laser.
  8. Finally, the urologist removes the stones through the scope using suction. Alternatively, the doctor may also use a grasper to retrieve the stone fragments from your body.
  9. For multiple stones in the kidney, this procedure may be repeated through other access sites, if required, until all the stones are removed.
  10. Post the operation, a soft tube or catheter is left through the incision for a day to drain the urine directly from the kidney into a drainage bag. Your recovery will be monitored closely until the catheter is removed.
  11. In case of small stones when Miniperc is done,Tubeless procedure is done(no tube is put through incision post procedure).
  12. One DJ Stent is put inside after stone removal,which is kept for 1 month for the purpose of proper drainage of kidney.Stent is removed after 1 month under local anaesthesia.Patients need not to stay in hospital after stent removal.

• What are the benefits of PCNL?

  For most patients with very large kidney stones the benefits of the PCNL procedure outweigh the risks

  1. It is a minimally invasive procedure, which means fewer complications as opposed to an open surgery.
  2. Multiple stones can be removed with PCNL.
  3. The PCNL procedure has a post-procedure stone-free rate which is greater than 97%.
  4. The patient experiences less post-operative pain as compared to an open surgery.
  5. The patient can return to his daily activities sooner when compared to an open surgery.