Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove kidney stones that are too large to be treated with other methods, such as shock wave lithotripsy or ureteroscopy.

Indications

• Large kidney stones (>2 cm in diameter)
• Staghorn calculi (stones that fill the majority of the kidney)
• Stones that are causing obstruction or infection
• Patients with a high risk of complications from other procedures

Procedure

The procedure is typically performed under general anesthesia. The patient is positioned in a prone position, and the skin is cleaned and prepared with an antiseptic solution.

1. A small incision (about 1 cm) is made in the back, and a needle is inserted into the kidney under fluoroscopic guidance.
2. A guidewire is then inserted through the needle, and a tract is created from the skin to the kidney using a series of dilators.
3. A nephroscope (a small telescope) is inserted through the tract, allowing the surgeon to visualize the stone.
4. The stone is then broken up using an ultrasonic or laser lithotripter, and the fragments are removed through the nephroscope.
5. A catheter may be left in place to drain the kidney and prevent bleeding.

Benefits

• High success rate for removing large stones
• Minimally invasive, resulting in less pain and scarring
• Shorter hospital stay compared to open surgery
• Faster recovery time

Risks and Complications

• Bleeding or hemorrhage
• Infection
• Damage to surrounding organs (e.g. bowel, spleen)
• Fluid overload or electrolyte imbalance
• Nephrocutaneous fistula (abnormal connection between the kidney and skin)

Post-Operative Care

Patients typically require:

• Pain management with medication
• Antibiotics to prevent infection
• Bed rest for several hours after the procedure
• Follow-up imaging studies to ensure stone removal and check for complications

Outcomes

The success rate of PCNL varies depending on the size and location of the stone, as well as the patient's overall health. In general:

• Stone-free rates range from 70-90%
• Complication rates range from 10-20%
• Mortality rates are less than 1%