Kidney stones are hard objects that are formed within the kidneys due to a buildup of certain types of chemicals in the urine. They may accumulate from excess calcium oxalate, struvite, uric acid, or cystine and can form in various sizes. Although uncomfortable, most cases of kidney stones can be passed at home without any medical intervention. However, if you experience a particularly large kidney stone or debilitating discomfort, there are several other treatment options. Your doctor will work through less invasive treatments first, but there are some instances where surgery is required. One surgical procedure to treat kidney stones is called percutaneous nephrolithotomy (PCNL). To help you better understand what this is, when it’s done, and what to expect, consider some of the details below.
What is Percutaneous Nephrolithotomy?
A percutaneous nephrolithotomy (PCNL) is a type of procedure that’s done to remove kidney stones from the body. They’re only performed when kidney stones can’t pass naturally on their own or with the help of non-surgical assisted technology. A passageway is surgically formed from the outside of the skin to the back of the kidney and specialized instruments are then inserted to locate and remove the kidney stone.
When would PCNL Be Used?
Since PCNL is considered an invasive procedure, it’s only used when less-invasive treatment options or procedures aren’t successful. It’s also the recommended course of treatment when the stones are too large and are blocking a branch of the kidney’s collection system (staghorn kidney stones). If your doctor finds that stones are larger than 2 centimeters in diameter, often using an ultrasound, a PCNL may be recommended as the first treatment option.
Potential Risks of Percutaneous Nephrolithotomy
Although percutaneous nephrolithotomy is considered a safe procedure, it’s still an invasive surgery. This means that there will be some risks involved. Some of them include:
- Organ Injury – this is an uncommon risk, but it can happen in some situations. Your doctor will be able to tell if this occurs during the surgery. Reparative surgery may be required as a follow up.
- Further Surgery – some kidney stones cannot be fully removed with the initial PCNL. If this is the case, your doctor may recommend additional treatment.
- Bleeding – bleeding during the surgery is common, but usually not too severe. In rare circumstances, patients may require a blood transfusion.
- Infection – during recovery, it’s important to keep the surgical site clean and sterile to reduce the risk of any infection. If you notice signs of infection, such as fever, incision drainage, discomfort, or ongoing pain, contact your doctor.
What to Expect When Undergoing Percutaneous Nephrolithotomy
Your doctor will work with you to determine an appropriate surgery date for your PCNL. Once set, it’s important to pay special attention to what you need to do for proper preparation. You’ll receive a set of pre-operation instructions from your doctor, which need to be strictly followed. This will often include stopping certain medications about seven to 10 days before your surgery, especially if they may interfere with your blood’s ability to clot. You’ll receive personalized recommendations based on the medications you were taking at the time of the appointment. You should also take care to avoid any infections leading up to the surgery, and if you notice signs of one (such as a UTI), contact your doctor to receive the appropriate treatment before the date of your percutaneous nephrolithotomy.
The Surgical Procedure
PCNL is performed under general anesthesia, so you won’t be awake during the operation. Your surgeon will use a series of urinary catheters and tubes to drain your bladder during the process. By administering a dye, the location of the stone can be determined. They will then enter percutaneously (through the skin) near your kidney to remove the stone using a nephroscope (camera device) and a nephrolithotomy, which is essentially a grasper. If the stones are too large, they will first be broken up with a laser and then removed, which is a procedure called a nephrolithotripsy.
PCNL Recovery and Follow Up
After your surgery, you will remain in the hospital for about one to two days. This is done to help your doctor monitor healing and reduce the risk of infections or complications with the surgical site. There are a few things that you should expect during your recovery from percutaneous nephrolithotomy, including the following:
Nephrostomy Tubes and Catheters
Upon waking up after surgery, you may notice a few tubes attached to bags or machines in your hospital room. Your doctor will discuss what to expect ahead of time so you’re not startled, but you will likely have a nephrostomy tube and/or urinary catheter. The nephrostomy tube will drain urine directly from your kidney into a bag. This is done to help aid in the healing of your kidney and the associated urinary tract. You may notice signs of blood, which should clear shortly after surgery. Your doctor may either remove the nephrostomy tube prior to discharge or keep it in place for one to two weeks during post-op recovery. Do not try to remove this on your own.
An indwelling catheter (Foley catheter) will also be used during surgery to keep your urinary tract empty. This will remain in place for about a day after your procedure so your healthcare team can monitor urine output and kidney function. It will be removed before you’re discharged, but your doctor may recommend further use of intermittent catheters at home.
Ureteral Stent
A ureteral stent is a small piece of flexible plastic that’s placed in your ureter to help promote kidney drainage during recovery. These can be inserted for a number of reasons, but in regard to PCNL they can help improve blockages caused by kidney stones. They will be removed in about one to two weeks after your surgery.
Discomfort
Since PCNL is a surgical procedure, it’s natural to experience some slight discomfort or post-operative pain. This should be contained to the flank region, where your kidney is located and will likely subside after a few days. Your doctor or nurse can help with pain management using either oral or intravenous medication. Once you leave the hospital, pain should be easily managed using over the counter remedies. Always check with your doctor regarding the list of approved medications to take until you’re fully recovered.
Nausea
Some patients may also experience a slight degree of nausea during their recovery. This is often caused by the general anesthesia and should wear off soon. If you’re unable to keep food or liquid down due to persistent nausea, your nurse can provide medication to help.
Physical Activity
Although it may cause additional discomfort, moving your body after surgery is an important tool to help reduce the risk of blood clot formation. You should always be supervised by a hospital staff or family member while you walk, but doing so on the evening following your surgery is recommended. Expect to be asked to get up and walk about four to six times per day throughout the hallways during your hospital stay. The more you’re able to walk, the lower your risk of blood clotting becomes.
You will receive post-op instructions on what to eat as you recover, but it’s important to take added effort to remain hydrated with clear liquids. It’s also completely normal to feel a general sense of fatigue during your PCNL recovery period. This may continue for a few weeks to a month, but varies between individuals. Cases of fatigue that continue longer than a month should be discussed with your doctor. Occasionally, PCNL procedures may not be completely successful and will require another operation called a “second look.” This is done to retrieve any lingering or leftover fragments of stone that may not have been accessible or retrieved during the first PCNL. Some individuals will undergo this prior to being discharged while others may return based on recommendations from their surgeon.
Individuals who have recently undergone percutaneous nephrolithotomy surgery will need to wear a urinary catheter during recovery. This will likely be an indwelling catheter while you recover in the hospital, but once you transition home your doctor may recommend continuing the use of intermittent self-catheterization. Byram Healthcare offers a wide range of urology supplies such as catheters and incontinence care to provide a customized approach to treating urological conditions and improving your path to recovery. Browse our products today and have them discreetly delivered at your door—most orders ship within 2-3 days.
Byram Healthcare is a member of the National Association for Continence’s Trusted Partners Program, whose mission is to provide quality continence care through education, collaboration and advocacy. We continue to build partnerships in the clinical community to ensure we focus on what’s best for the patient.
