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Percutaneous Nephrolithotomy (PCNL)

WHAT IS A PCNL?

Percutaneous – means through the skin. Nephrolithotomy – is a combination of the words nephro (kidney), litho (stone) and tomy (removal). Nephrolithotripsy – is a combination of the words nephro (kidney) litho (stone) and trispy (crushed). PCNL may be a combination of both of these.

This procedure is a treatment for kidney stones where patients have large or multiple stones measuring greater than 2cm of total stone burden. They involve entering the kidney through a small incision in the back. The purpose of the procedure is for the removal of the renal calculi in order to relieve pain, bleeding into or obstruction of the urinary tract, and/or urinary tract infections.

WHAT DOES THE PROCEDURE INVOLVE?

The procedure is performed under a general anaesthetic and lasts approximately two hours. It is a team effort requiring coordination between your surgeon, anaesthetist and radiographer. The procedure is accomplished with the assistance of x-ray imaging / ultrasound to guide the entry of a hollow tube into the kidney, through a keyhole incision in your back. This provides access into the kidney drainage system allowing telescopes, lithoclast (small high frequency jack hammer), laser fibres and stone grasping instruments to visualise, fragment and remove the kidney stones.

A nephrostomy tube (a drainage catheter that’s inserted through your skin and into your kidney to drain urine) will be inserted at the conclusion of the procedure. The nephrostomy tube drains urine from the kidney into a drainage bag. You will also have an indwelling catheter (IDC) in place to allow your urine output to be measured from the bladder. You may also have a ureteric catheter draining into the IDC. A ureteric catheter is a small flexible plastic internal tube that is placed into the ureter to further promote drainage of your kidney in conjunction with the nephrostomy. The nephrostomy tube, ureteric catheter and IDC will all be removed prior to you being discharged from hospital, approximately 2 days after your procedure. If a ureteric stent is placed, its removal will be determined by your surgeon, depending if further procedures need to be performed for your stones.

WHAT CAN I EXPECT AFTER THE PROCEDURE?

  • Pain in the flank area overlying your kidney is common for the first few days.
  • Blood staining of the urine for up to a week after discharge from hospital is normal and should not alarm you, provided it is not getting heavier.

WHAT ABOUT DIET?

  • Drink plenty of fluids (8-10 glasses or 2-3 litres, unless you are on a fluid restriction due to a heart condition)
  • Avoid acidic drinks such as orange or cranberry juice which may increase burning, stinging and irritate the bladder
  • Eat a diet high in fibre to prevent the need for straining when using your bowels

WHAT ABOUT EXERCISE/ACTIVITY?

  • Avoid for 4 weeks after surgery unless otherwise instructed by your doctor:
    • strenuous activity
    • heavy lifting (eg. grocery shopping, picking up children)
    • engage in sports
  • Avoid driving a car for 1-2 weeks
  • There is no restriction on walking

WHAT ABOUT MEDICATIONS?

  • You can resume your usual medications
  • If your blood thinning medication was stopped, your Doctor will let you know when to recommence
  • You can take 1-2 paracetamol every 4-6 hours for pain and discomfort (no more than 8 in a day)
  • Ural sachets (urine alkaliser) available from chemists and supermarkets, reduce acidity of the urine and provide relief from symptoms such as burning and stinging

WHAT ARE THE POSSIBLE COMPLICATIONS?

  • Bleeding in the urine or around the kidney
  • Infection in the urine or around the kidney
  • Injury to structures around the kidney (eg. bowel, lung)
  • Urine leak
  • Incomplete stone clearance or fragments of stone dropping into the ureter (tube between the kidney and the bladder) causing obstruction
  • Inability to make a large enough track to insert the nephroscope
  • Arteriovenous fistula. This is a connection between an artery and a vein in which blood flows directly form the artery into the vein

NOTIFY GEELONG UROLOGY or your GP if you experience any of the following:

  • Heavy bleeding – urine that looks like pure blood
  • Worsening pain over the ensuing days following your operation. If the pain continues to escalate despite the use of oral pain medications, this may indicate obstruction of the kidney from a large stone fragment lodged within the ureter, a hematoma around the kidney or infection
  • Fever (temperature over 37.5 degrees), chills, shakes or feeling generally unwell
  • Signs and symptoms of a urinary tract infection – burning when voiding, frequency or urgency, offensive smelling urine, cloudy looking urine
  • Increasing difficulty or unable to pass urine

FOLLOW UP APPOINTMENT

Your doctor will generally speak to about the results of the procedure before you are discharged home and an appointment for your follow-up in approximately 4 weeks will be organised. If an appointment time is not given to you on discharge from hospital, you will need to phone Geelong Urology to make an appointment.

If you have any queries please contact Geelong Urology on 03 5229 9105 during business hours OR leave a message on the After Hours Urology Paging Service