Percutaneous nephrolithotomy is a minimally invasive surgical procedure in which kidney stones are removed through a small skin incision (percutaneous) over the abdomen. This procedure removes the big stones (>2 cm) which cannot pass through urine and require surgical treatment.
The benefits of a percutaneous nephrolithotomy over other surgical methods are as follows
- Less invasive
- Less bleeding
- Fast recovery
- Quick discharge from hospitalization
Alternative name
Kidney stone extraction
Body location
Kidneys, ureters, urethra
How is a percutaneous nephrolithotomy performed?
This procedure is performed under general anesthesia to reduce the pain and discomfort of the patient. The patient is positioned on the stomach, and a small cut of 1 cm is made on the back of the body. A hollow tube is gently placed inside the kidney under the guidance of an X-ray, and the stone is removed by surgical tools attached to this tube out of the kidney. A drainage nephrostomy tube is kept in the kidney along with a urethral catheter to drain urine out of the bladder. The patient is hospitalized for 2-4 days, depending on their health condition. A post-surgery X-ray is taken to ensure the complete removal of the stone. DJ stent is usually placed during the procedure and removed after 2 weeks.
Preparation before the procedure
Some specific imaging tests like an abdominal ultrasound, computed tomography scans, magnetic resonance imaging, etc., are performed to locate the kidney stones before the surgical procedure. The patient is also asked to perform a mid-stream urine test. Other tests that may be needed are as follows:
- kidney function test
- Complete blood count
- Bleeding and clotting profile
Procedure type
Percutaneous surgical procedure
Follow up
The patient is asked for a follow-up after a week, where some tests are repeated to ensure the success of the procedure. The catheter is also checked and is removed after evaluating kidney function. Antibiotics and painkillers are prescribed to prevent any wound infection and reduce the pain. In case of any severe infection, pain, or fever, it is recommended to contact the urologist. After a few days, the doctor will ask the patient to move around a bit, slowly regaining normal activities. It is advised not to lift heavy objects for some time or engage in some strenuous activities post-surgery.
Risks associated with a percutaneous nephrolithotomy
This procedure is safe; however, certain risks are associated with any surgical procedures are as follows:
- Post-operative bleeding: It can occur as a part of injury during the procedure or because of the dislodgement of tissue scars during the healing process.
- Post-operative infection: It can occur because of the presence of infection inside the tissue. However, it can be treated using broad-spectrum antibiotics to reduce the chances of further infections.
- Failure to remove stone: Although uncommon, it can occur if the size of the stone is small or if it breaks during the surgery. In that case, an alternative approach is used to retrieve stones.
- Tissue injury: It can occur during the placement of a tube or a stent inside the kidney or ureter, which causes pain and bleeding.
Recovery after a percutaneous nephrolithotomy
Usually, it takes several days to weeks to recover from this surgical procedure, which depends on the health of the person being treated. It is normal to see blood-tinged urine for some days post-surgery. However, if there is pain and severe bleeding, contact the doctor immediately. The patients start functioning properly after 2 weeks, but proper rest and care should be continued along with a healthy diet for several weeks. The doctor may make some dietary changes to avoid the formation of stones. Water intake should be kept optimal to flush out tiny stones, if any, and reduce the further chance of stone formation.
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