North Bay Ontario

PCNL

Percutaneous Nephrolithotomy

(Complex Stone Disease)

Urology North

Call Us:  +1-705-995-2490

Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to treat large and complex kidney stones.  The procedure is done by placing a small stent into the renal pelvis in a retrograde fashion through the urethra.  This allows dye to be instilled into the renal pelvis and a x-ray can then be used to guide a needle into the collecting system of the kidney through the back.  This allows a wire to be placed and a balloon dilator used to create a tract into the kidney.  Once this tract is created a endoscopic camera can be used to visualize directly into the renal pelvis and a number of techniques can be utilized to remove the offending stones.  

 

The procedure

PCNL is a surgical procedure performed in the OR under a general anesthetic.  You should not feel any pain during your procedure.  The surgery is performed by inserting a very small catheter up the tube that connects the bladder to the kidney on either side.  This allows a wire to be placed through the back to gain access to the collecting system.  This can be done for a number of reasons, but the most common is to break up particularly large or difficult kidney stones.  There are different energy sources that can be utilized to break up the stones during this surgery but the most common are ultrasound pneumatic devices and laser fibers.  

Risks

All surgical procedures have inherent risks associated with them.  Despite these risks being very low, we believe it is important that all patients who choose a surgical option are aware of the potential for unwanted outcomes.

PCNL is a very safe procedure, however, the risks do include anesthetic complications such as MI, Stroke, adverse drug reaction, or even death.  Specific to the surgery, damage to the ureter, including ureteral evulsion is a rare but real risk.  Common risks include blood in the urine, pain, and urinary urgency.  Urinary tract infection can be introduced with the scopes rarely.  PCNL can be a technically challenging procedure and occasionally, for a multitude of reasons, we simply cannot successfully remove all of the stone.  Significant blood loss requiring a transfusion can sometimes occur.  Damage to adjacent organs is a rare complication that can occur due to placement of the wire and needles.

After PCNL

After the PCNL you will be brought to the recovery area to wake from your anesthetic.  Blood and burning with peeing is normal for several days.  Almost always, you will be left with a soft rubber stent connecting the kidney to the bladder.  This is a temporary tube that will be removed by undergoing a cystoscopy at a later date.  Historically, PCNL was performed as an in-patient procedure requiring 1-3 days in hospital.  With an improvement in technique and equipment, PCNL can now sometimes be performed safely as an out-patient procedure.  If the decision is made to proceed as an out-patient, you will have blood work (to check hemaglobin) and sometimes a chest-x-ray (to assess the lungs for pneumothorax)  prior to discharge.  You will be given pain medication for a few days after the surgery.  2 small stitches will be left in your flank, both are absorbable and will dissolve on their own.

Your doctor will discuss the results of the surgery and will book a follow up appointment in the cystoscopy clinic.  You will be discharged home with a prescription for pain medication to be used as needed.

As mentioned, blood and burning with voiding is normal after this procedure.  It is recommended that you drink water and other fluids regularly and empty your bladder often to speed up the disappearance of these symptoms.

When Should I Call my Doctor?

You should contact our office if your bleeding or burning persists for more then a few days, if you are having a hard time passing your urine of if you develop a fever.  If you are developing any symptoms of significant bleeding, such as being very weak and pale, you should also seek medical attention.

Q&A

1. What is the advantage of PCNL over ureteroscopy or shockwave lithotripsy?

     PCNL is a surgical technique that allows for the treatment of complex and large kidney stones that would otherwise be difficult or impossible to treat in a minimally invasive fashion with ureteroscopy.  It is a more invasive surgery than ureteroscopy, but still affords a significantly quicker recovery time than an open procedure would.  Like all surgery, PCNL has very specific indications, and we at Urology North strive to provide the least invasive procedure possible to deal with your particular issue.  If PCNL is felt to be the optimal choice in your situation we will review the benefits and risks compared to other techniques available.

2. Will it hurt

     During the procedure you will be asleep and will not feel any pain.  After the surgery it is common to have some discomfort on the side of the surgery.   A short course of pain medication following the procedure is typically required for a few days.

3. How long will it take

     The procedure varies from a one to several hours depending on the indication and how technically difficult the stones are.  Despite this, we are still often able to consider discharge the same day.  Sometimes, for observation or pain control, a hospital admission overnight is required.