PCNL

Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large kidney stones or a collection of smaller stones that cannot be treated with less invasive methods like shock wave lithotripsy or ureteroscopy.

Purpose:

PCNL is performed to address kidney stones that are:

Too large to pass naturally through the urinary tract
Causing severe pain
Leading to urinary tract infections or kidney damage
Causing obstruction in the urinary system

Procedure Steps:

Anesthesia: The procedure is usually performed under general anesthesia to ensure the patient is asleep and pain-free during the surgery.
Access to the Kidney: A small incision is made in the back, and a narrow, hollow tube called a nephrostomy tube is inserted through the skin directly into the kidney. This can also be done using a minimally invasive technique called a percutaneous approach.
Guidewire Insertion: A thin wire is passed through the nephrostomy tube into the kidney. This wire acts as a guide for other instruments.
Dilation: Using special instruments, the surgeon dilates the tract to create a wider passage to the kidney. This allows for the insertion of larger instruments needed to remove the stones.
Stone Removal: A nephroscope, a small tube with a camera and instruments, is inserted through the tract to locate and remove the stones. Different techniques like breaking the stones with a laser or using mechanical devices are employed to break up and extract the stones.
Drain Placement: Once the stones are removed, a tube (nephrostomy tube or stent) may be left in place temporarily to drain urine and any residual stone fragments.

Aftercare:

Hospital Stay: Patients might stay in the hospital for a day or two after the procedure.
Pain Management: Pain medication is often prescribed to manage discomfort after the surgery.
Activity Restrictions: Patients are advised to limit physical activity for a certain period to aid healing.
Follow-up: Follow-up appointments are crucial to monitor healing and remove any remaining tubes or stents.

Risks and Considerations:

Bleeding: Bleeding is a potential risk during and after the procedure.
Infection: Infection is a risk, especially because the procedure involves the urinary tract.

Residual Stones: Complete removal of all stones might require additional procedures in some cases.
Damage to Nearby Organs: Rarely, adjacent structures might sustain damage during the procedure.

PCNL is a highly effective procedure for the removal of large kidney stones, but as with any surgical procedure, it carries certain risks. The decision to undergo PCNL is typically made based on the size and location of the kidney stones and the patient's overall health condition. Discussing the benefits and risks with a healthcare provider is essential to make an informed decision about treatment options.