The most effective of the commonly performed procedures for kidney stones is percutaneous nephrolithotomy (PCNL) and is the best procedure for large and or complex stones. The surgery consists of the urologist making a ½ inch incision in your back, through which is placed a hollow tube that provides access to the inside part of your kidney that contains the stone(s). Using a rigid metal telescope, the stones are removed directly or broken into fragments which are removed.
Because of the incision in the skin and the tube placed into the kidney, PCNL carries more risk than the other commonly performed procedures kidney stones, and it also requires at least an overnight stay in the hospital. It cannot be performed in patients on anticoagulation or those with uncorrected bleeding disorders.
What you should anticipate:
- Lab tests and X-rays will be obtained to ensure your safety during the procedure.
- You will receive an antibiotic, either by mouth or through an IV, right before the procedure.
- The anesthesia team will attach monitoring devices to you. In almost all cases, you will be placed under general anesthesia for this procedure.
- You are taken to the Radiology Suite, where the entire procedure will be performed.
During the procedure
- After you are asleep, the surgical team places you very carefully into the prone position (on your abdomen).
- The urologist and radiologist work together to place the hollow tube in the part of the kidney that provides the best access to your stone(s).
- Your urologist then removes the stone(s), either directly or after breaking them into smaller fragments.
- The procedure can take as little as an hour or as long as several hours.
- A temporary plastic tube is left inside you at the conclusion of the procedure.
- One type of tube, called a “nephrostomy tube,” exits out of the small incision that was made in your back.
- Another type of tube, called a “stent,” is completely internal.
- Your urologist will decide which tube to use based on many factors.
- A plastic catheter is also placed in your urethra.
- After the procedure, you will be moved to the post-operative recovery area, usually for about 2 hours.
- After waking up adequately, you will be taken to the Surgical Short Stay Unit where you will transfer to a more comfortable bed. Family members in the waiting room will be notified of your transfer and are allowed in to see you once we have you settled. You can usually expect to stay in the Surgical Short Stay Unit for one to two nights after your procedure.
- The Surgical Short Stay Unit does not have individual patient rooms. It is set up similar to the pre- and post-op rooms, with beds separated by curtains, which allows the nursing staff to closely observe you and to respond quickly to your needs. Please note that cell phone reception in the Surgical Short Stay Unit is poor.
- Your urine will drain out of the tube in your urethra and, if there is one present, the tube coming out of the incision in your back. You will notice some blood mixed with the urine in one or both tubes.
- The morning after surgery, if the blood in the urine has decreased enough, the tube(s) might be removed. The tube in the urethra is removed by deflating the balloon that has held it in place, and then it gently slides out. The tube coming out of the incision in your back, if it is present, is removed in the Radiology Suite after taking an X-ray. If an internal tube (“stent”) has been inserted, in many cases it is removed while you are in your hospital bed with a thread exiting out of the small incision in your back. In other cases, the stent will be removed 1 or 2 weeks after you are discharged from the hospital with a minor procedure in your Urologist’s clinic.
- If the tubes are not removed on the day after surgery, because there was too much blood in the urine or for some other reason related to your procedure, they usually are removed the following day.
- After tubes are removed, and after you have been able to urinate, you are discharged from the hospital.
- In some cases, you will be discharged with one or more tubes still in place. We will teach you and your family how to care for those tubes, and home nursing assistance will be provided if needed.
- You will be provided with oral narcotic tablets for pain relief at home. You may or may not be given antibiotic pills, depending on a number of factors.
- You should avoid strenuous activity or heavy lifting for the week following the procedure. After that week, most people can resume normal activities without pain.
- You will have a follow up visit with your urologist approximately 6 weeks after surgery.
- At that time, an X-ray will be taken to determine the procedure’s success and to assess for any complications.
- Depending on your risk of recurrence, you may be offered further testing to help prevent future stones.