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Percutaneous nephro lithotomy

PCNL is a procedue used to remove stones in the kidney. Especially when they are larger than 1.5 cms. We need an intravenous urogram know the anatomy of the kidney and to know the location of stone inside the kidney. Once the anatomy and stone position in the kidney are identified. Then a hole is made into the kidney where the stone is located by the help of X rays. Then the hole is dilated by a serial dilating device. The hole is made as big to accomodate a nephroscope. Nephroscope is special endoscope designed to view insides of kidney. Nephroscope is passed into the kidney and stones were identified. Now stones are broken using lithotriptor or laser. Broken stones are removed through the same hole. Fine powdery fragments which cannot be removed are left behind. This will pass through urine. DJ Stent will be replaced to assist in passing out of small fragments. Before the invention of these procedures stones larger than 1.5 cms were removed by opening the kidneys. This is a better technique where there is less blood loss when compared to open technique. The stone clearance is much better. The patient returns to back to normal activities with in a week. The patient will come back for DJ Stent removal after 2-4 weeks.

Pre-operative preparations

The patient will be admitted in the hospital on the previous day of the surgery. After admission patient's blood and ECG tests will be conducted and chest X-ray will be taken. A consultation with Physician as well as Anaesthetist will be obtained prior to surgery for anaesthesia fitness.Two units of blood will be arranged for use in case of any emergency. The patient has to fast for at least six hours before the surgery. The time of the surgery will be intimated in advance.

Post operative care

The surgery usually lasts more than two hours and the total time taken depends on the size and hardness of the stone. After the surgical procedure the patient will be brought to the recovery ward where he will be under intensive care. On the next day of the surgery the patient will be able to walk in the room and he will be allowed to have light food. The urinary catheter carried by the patient will be removed within one or two days and the nephrostomy catheter will be removed only after additional one or two days depending upon post operative factors. However urine will be leaking through the track in the back for a few days more. A special bag will be attached to the wound to collect the dripping urine. After two three days the patient will be able to move around freely and have normal diet. By fourth day or so the urine leak would have stopped and you will be able to go home. Urinary tract infection can occur post operatively and this may delay the discharging of the patient from the hospital. The patient is expected to take leave from work for about one week. Follow the instructions given by the doctor at the time of discharge.

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