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
   1   2