Percutaneous Nephrolithonomy (PCNL)

Kidney stones are made in the urinary tract as a result of crystallization of chemical compounds in the urine. PCNL is a method used to take out certain stones in the kidney or upper ureter that are too large for other forms of stone treatment like shock wave lithotripsy or ureteroscopy.

The Surgery

This procedure has been carried out on many patients over the last several years and is accepted standard of care for patients with kidney stones that are large, very firm, or resistant to other types of stone treatment. As such it has replaced open operations for kidney stones in the huge majority of patients.

Usually, the length of the surgery is three to four hours. The procedure is performed by making a small 1 cm incision in the patient’s flank area. A tube is inserted through the incision into the kidney under x-ray guidance. A small telescope is then put through the tube in order to visualize the stone, break it up and get it out from the body. If necessary, a laser or other device called a lithotripter may be used to break up the stone before it can be taken out. This surgery has brought about less post-operative pain, a shorter hospital stay and earlier return to work and daily activities.

This method also has a higher success rate for clearing all stones in one setting than other techniques such as extracorporeal shock wave lithotripsy (ESWL), which often require numerous attempts.

Potential Risks and Complications

Although this surgery has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar to that of open surgery. Potential risks include:

• Bleeding: Some blood loss will happen with this procedure but rarely do patients need a blood transfusion. If you are interested in autologous blood transfusion (donating your own blood) you must inform your surgeon. When the packet of information is mailed to you regarding your surgery, you will also get an authorization form for you to take to the Red Cross. You must coordinate this with the Red Cross in your district.

• Infection: All patients are treated with broad-spectrum antibiotics to reduce the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgical procedure (like fever, drainage from incision, urinary frequency or discomfort, pain or anything that you may be concerned about) please contact us at once.

• Tissue / Organ Injury: Although rare, possible injury to nearby tissue or organs as well as bowel, vascular structures, spleen, liver, lung, pancreas and gallbladder could need additional surgery. Loss of kidney function is uncommon but is a potential risk. Scar tissue may also form in the kidney or ureter, thereby requiring further surgery.

• Conversion to open surgery: This surgical procedure may need conversion to the standard open operation if difficulty is encountered during this surgery. This could lead to a larger standard open incision and probably a longer recuperation period.

• Failure to Remove the Stone: There is a possibility that the stone(s) cannot be able to be removed completely, usually either due to the size or location of the stone(s). Additional treatment may be needed.

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