Page 1 - Percutaneous Nephrolithotomy
P. 1
Urological Health
Percutaneous
nephrolithotomy
A percutaneous nephrolithotomy is a surgical procedure to remove kidney stones through
a “keyhole” incision.
ercutaneous nephrolithotomy (PCNL) is a surgical Pre-operative antibiotics may be recommended.
Pprocedure in which kidney stones are removed Your urologist may require special X-rays prior to the
using a scope passed through a small skin incision procedure to help with planning how to reach and
made in the flank or the back into the kidney. remove all of your stones.
The procedure is usually recommended for patients Establishing the tract (access)
with kidney stones that are too large or numerous for
shock wave lithotripsy, in which stones are broken PCNL first requires developing an access or
up non-surgically. The procedure involves two major channel through the skin to the kidney allowing the
steps. The first is establishing a tract or access path introduction of surgical instruments. There are different
into the kidney containing the stones, and the second methods of establishing this access into the kidney. In
is stone fragmentation and removal using special some cases, this part of the procedure is performed
operating instruments. under local anaesthetic (“freezing”) by a specialist
in the X-ray department prior to the stone removal
procedure. Otherwise, this part of the procedure can
be performed at the same time as the stone removal
procedure, usually under general anesthesia (you are
“put to sleep”).
This access is often obtained by first passing a thin
Roula Drossis needle into the kidney. Once this access is performed
a wire or drainage tube will be left until the second
part of the surgery takes place. Some surgeons prefer
to gain this access from inside-out by passing a thin
nephroscope needle under x-ray control through the bladder up to
the kidney and out through the skin. In some cases,
more than one access tract is required to reach all of
~1 cm incision
the stones.
sheath
Stone removal
kidney
In the operating room, the access tract is stretched
kidney stone to allow the introduction of surgical instruments. Once
the tract is dilated up to about one centimetre (less
than half an inch) a plastic sheath is then placed into
the kidney. An operating scope (nephroscope) is then
passed through the tube into the kidney on to the
Before the procedure stone(s). Small stones can be removed with a grasper.
Larger stones need to be broken up before they can
be removed. An attempt is made to remove all of the
The risk of bleeding is increased in patients taking stones. In some patients this may not be possible and
blood thinners, aspirin, some arthritis medications may require additional treatment.
or many herbal supplements. These drugs must be
stopped prior to surgery. Please discuss this with your
urologist. Continued on next page