Perctaneous Nephro-Lithotomy (PCNL)

Endoscopic surgery with trans-cutaneous access through lower lumbar area. Indicated for stones lager than 1,5cm, situated in the kidney.

Why is it done?

• Renal stones usually larger than 1,5cm obstructing/ non-obstructing the renal pelvis.
• Staghorn calculus.
• Quicker removal, more effective removal.
• Higher stone free rates in less time.
• 90% of patients are stone free after this procedure.
• You may present with excruciating pain on the affected side if the stone is lodged at the pelvi-uretric junction. (This pain may be worse than child-birth).
• Non-obstructing renal stones may not cause any symptoms, yet need to be treated to prevent enlargement and future renal failure and sepsis.
• Any fevers or a single kidney is deemed an emergency! This requires urgent stenting or a nephrostomy prior.

Treatment Options

• Single Entry.
• Multiple Entry, Staged procedure for stag horn calculi or multiple stones.
• Use of a combined flexible nephroscopy with laser in those difficult corners.

How is it done?

• • Patients will receive a general anaesthesia.
  • Prophylactic antibiotics is given.
  • The correct kidney is identified and marked while you are awake.
  • A cystoscopy with retrograde pyelogram will be done with placement of ureteric occlusion catheter to enable filling of the renal collecting system, aiding in the initial percutaneous access to the kidney.
  • You will then be placed prone (face down) on the operating table with good support.
  • Using radiological imaging a needle will be placed into the desires calyx (collecting system) of the kidney.
  • A guidewire will be placed and the tract dilated to allow the access of the nephroscope.

• Either the lithoclast or laser will be used to fragment the stone.
• All fragments will be attempted to be cleared. Small 1-2 mm fragments may be left as “Clinically Insignificant Fragments CISF” and will pass spontaneously.
• A nephrostomy tube (drainage tube) is left post-operatively for a few days until bleeding settles.
• A CT scan will be done the following day to determine whether all the stones have been removed.
• In the event of residual stone being present, the recommendation may be made to keep the nephrostomy tube in longer until an appropriate time on a theatre list can be accessed to remove the remaining calculus.
• Should you be stone free, your nephrostomy tube will be removed followed by your indwelling catheter a day later.
• Urine leakage from the puncture site may persist for a few days until the wound heals over.

Options for Residual Fragments

• Keep nephrostomy until appropriate date to re-enter the same tract and remove the rest of the stone.
• Remove the tube and plan for ESWL ( Extra-Corporeal Shock Wave Lithotripsy).
• If radio-luscent: possible dissolution therapy.

What next?

• You may spend at least 3-5 nights in hospital.
• You may have a catheter for that time.
• You may have a nephrostomy tube in the affected kidney for at least 3 days.
• You may have a check CT scan the following day to confirm stone clearance.
• After removal of the nephrostomy tube, you may experience urine leak from the wound site for a few days.
• Your catheter will be removed a day after.
• You may be discharged as soon as your pain has stabilised and you can function independantly.
• Allow for a few days for stabilization of symptoms.
• A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
• A follow-up appointment will be scheduled for 6 weeks. Stone analysis results will then be discussed in order to formulate a plan to proven recurrences.
• Don’t hesitate to ask Jo if you have any queries.
• DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Types of Stones:

• Calcium Oxalate.
• Uric Acid.
• Calcium Phosphate.
• Struvite (Infection stones).
• Cystine.

Download Information Sheet

Percutaneous Nephrolithotomy