For kidney and ureteral stones that are too large (usually larger than 2 centimeters), too numerous, or too dense to be treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy, PCNL (percutaneous nephrolithotomy or stone extraction) offers a minimally invasive method of removing these stones.
Historically, large kidney and ureteral stones were removed through open surgery, requiring a large flank incision. Percutaneous nephrolithotomy is performed through a 1-cm skin incision and thus minimizes incision size, pain, blood loss, blood transfusions and shortens hospitalization. This technique also has a higher success rate for clearing all stones in one setting than other techniques such as ESWL, which often require several procedures.
The Surgery
PCNL is performed under general anesthesia with the patient lying face down on their abdomen. Once anesthesia is administered, your surgeon will perform cystoscopy (telescopic examination of your bladder) and instillxray dye or carbon dioxide into your kidney through a small catheter placed up through the ureter or drainage tube of the affected kidney to “map” the branches of the collecting system. This allows urologist in Muzaffarpur to precisely locate the stone within the kidney and place a small needle through the skin under xray guidance to directly access the stone.
This needle tract is dilated to approximately 1-cm to allow placement of a plastic sheath and telescope to directly visualize the stone. Using an ultrasonic, mechanical or laser lithotripsy device, the stone is fragmented into small pieces and extracted out of the body through the sheath. On occasions, more than one tract may be required to access and attempts removal of all stones.
A small ureteral stent may be left draining the kidney to the bladder in addition to a nephrostomy tube draining the kidney to an external drainage bag at the end of the operation. The length of the surgery is generally 3-4 hours.
