Product Summary: Removal of large renal calculi through an endoscopic procedure through the skin of the back
Item number: 36639, 105, 36645, 105
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.
- 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.
- 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).
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