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Who is suitable for Percutaneous nephrolithotomy (PCNL)?

What are the advantages of Percutaneous nephrolithotomy (PCNL)?

How is Percutaneous nephrolithotomy (PCNL) performed?

What to expect after Percutaneous nephrolithotomy (PCNL)?

Percutaneous nephrolithotomy (PCNL) outcomes

INTRODUCTION

Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure that allows direct access to the kidney to treat large or complex kidney stones. In some cases a combined approach with 2 surgeons using Percutaneous nephrolithotomy (PCNL) and ureteroscopy can be used to very efficiently and effectively treat large stones.

Doctors Shekib Shahbaz and Tony De Sousa of Melbourne Urology Centre are high-volume experts in performing stone surgery. They have access to a wide range of equipment including start-of-the-art high powered holmium laser, which allows them to perform very safe, fast and effective kidney stone treatment.

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Who is suitable for Percutaneous nephrolithotomy (PCNL)?

    Those experiencing symptoms related to kidney stones including

    • Back or flank pain
    • Sweating and nausea
    • Blood in the urine
  • Those who have tried other non-surgical treatments that have not worked
  • Those who have kidney stones that are too large to pass without intervention
  • Percutaneous nephrolithotomy (PCNL) is generally reserved for stones larger than 1.5cm, multiple or complex stones (staghorn)

What are the advantages of Percutaneous nephrolithotomy (PCNL)?

  • Only a very small single skin incision (~1cm) is required for keyhole access
  • Gives the surgeon a direct view of the urinary tract
  • Very large stones are able to be cleared efficiently in one procedure
  • Stone fragments can be retrieved and analyzed to determine composition – this can assist in developing future stone prevention strategies
  • Can be performed as combined approach incorporating ureteroscopy with 2 surgeons for complex stones

How is Percutaneous nephrolithotomy (PCNL) performed?

  • The procedure is performed under general anaesthetic and generally takes 1-2 hours to complete, depending upon the size, number and position of the stones
  • Under xray guidance, a needle is passed directly into the kidney; the tract is then gently dilated to allow the insertion of a temporary sheath to allow direct access to the stone
  • A small telescopic instrument (nephroscope) is passed directly into the kidney
  • The stone is located and fragmented or can be disintegrated with holmium laser or ultrasound
  • Stone fragments are then removed by the surgeon
  • In most cases, a temporary soft rubber tube (nephrostomy) is left in place overnight to allow urine drainage and to minimize bleeding
  • In other cases, a temporary internal stent may be placed in the ureter in order to ensure good urine drainage

What to expect after Percutaneous nephrolithotomy (PCNL)?

  • Most patients will remain in hospital for one night
  • If you have a stent in place, you will need to return to have it removed after a week or so – this is a very minor procedure performed under sedation with a small telescope (flexible cystoscope)
  • It is not uncommon to see some blood in the urine in the days following the procedure. You may also feel the urge to urinate frequently if you have a stent in place
  • Most patients will have some discomfort in the flank area for a few days following the procedure
  • The risk of major bleeding or kidney damage is uncommon
  • It is important to drink plenty of water to help with flushing the stone fragments out through the urine
  • Normal light activities can be commenced within 2-3 days
  • You should avoid any strenuous activity for 4 weeks following this procedure to minimize the chance of bleeding

Percutaneous nephrolithotomy (PCNL) outcomes

  • Percutaneous nephrolithotomy (PCNL) is a safe and effective procedure for the treatment of large or complex kidney stones
  • Resolves the common symptoms associated with kidney stones
  • Percutaneous nephrolithotomy (PCNL) allows the vast majority of patients to be cleared of stones with one procedure
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