PCNL (Percutaneous Nephro Lithotripsy)
Some stones in the kidney and upper ureter have to be dealt with by this technique. Frequently, this is because the stone is too large, or too hard to be dealt with other techniques.
A 1cm track is made from the skin from the back, to the kidney. This is done under X-ray control. Through this track a special telescope is passed in to the kidney to look inside the kidney and visualize the stone. A stone breaking probe is then passed through this telescope and the stone broken with the probe or by holmium laser. All this is continuously seen on a video screen. The fragmented stones are removed leaving only the very small bits, which are subsequently passed in the urine.
A special tube called stent is often passed from the kidney to the bladder to allow the passage of these small stones, pain free. This is subsequently removed in a about 14 days as an outpatient procedure.
A special X-ray - IVU/CT is done before planning surgery.Medical fitness for general anesthesia
will also be assessed before admission.
Routine for a Fit Person
- 1. Admit at appointed time 1 day before surgery for the following procedures.
- May have to arrange 2 units of blood.
- Preparation for surgery – laxatives.
- 2. Day of surgery
- Time of surgery will be intimated by me the day before. Depending on when the previous surgery would get over, there may be a delay of an hour.
- The surgery may last from 2 hours or more depending on the size, site and hardness of the stone.
- On the day of surgery, you will be in the postoperative ICU.
- You will have a urinary catheter (tube in to the bladder) and a nephrostomy tube (a tube through the 1cm skin wound at the back, in to the kidney)
- 3. 1st day after surgery.
- You would be able to go back to your room and be able sit up and walk and have a light diet.
- The urinary catheter & nephrostomy tube will be removed in a day or two. However, the nephrostomy tube may be maintained for another day or two, depending on some post operative factors, such as adequate stone clearance, bleeding etc.
- 4. 2nd day after surgery
- The nephrostomy tube would have been removed in most people.
- However, urine will continue to leak from kidney, through the track in the back for another few days. This usually stops in 48 hours. To prevent your clothes from getting wet, a special bag will be stuck on the wound to collect the urine. Please keep ready a few (5) thin towels (thorthu) to tie below the bag, to catch any draining urine.
- You will be able to move about quite easily and have a normal diet.
- The urinary catheter is removed when urine leak through the keyhole site has stopped. This is usually one day after removal of the nephrostomy tube .
- 5. 4th day after surgery
- Usually by the 4th day, the urine leak would have stopped and you will be allowed to go home. Post operative urinary track infection can occur for this procedure, and is the usual reason for any delay in sending you home.
Restrictions at Discharge
- Take leave from work for 2 weeks. You can go about your normal activities at home.
- Report to the doctor if you suspect urinary tract infection.
- Follow the instructions of the doctor at discharge.