Percutaneous Nephrolithotomy

What is it?

 

A percutaneous nephrolithotomy is an incision into the kidney for removal of calculi or to break up the stone using a telescope.  If breaking up of the stone is done further surgery may be needed to remove other pieces of the stone from within the kidney.

 

Before the procedure

 

You will be told when to stop eating and drinking prior to the procedure.  You should discuss with Dr Bourne before the procedure if you have any allergies or any medication you are taking, particularly if Aspirin / Arthritis medication or Warfarin.

 

How is it done?

 

A cystoscopy (telescope into the bladder) will be done first to put the catheter (rubber tube) through the opening of the ureter (the tube that carries urine from the kidney to the bladder) and into the kidney.  Contrast medium can then be injected along this tube into the kidney so that the kidney can be seen on X-ray during the procedure.

 

After being placed in a face down position, a needle is put into the loin to puncture the kidney, with the X-ray guiding the way.  Once the kidney is punctured, the tract is slowly widened.  The kidney is then inspected with a telescope called a nephroscope.  Small stones can then be removed.  If the stone(s) are too big, the stone(s) will be shattered using mechanical energy, with a Lithoclast or ultrasound. 

 

After the procedure

 

After the operation, a tube is passed into the kidney, exiting the body through the same wound.  Two or three days after the operation and before the tube is removed, an X-ray may be taken by injecting contrast medium through the drain into the kidney.  If there is no blockage, the tube will usually be removed.

 

The findings of the procedure will be discussed with you before you go home.  If biopsy samples are taken these results can take up to 5 days to come back, in this case you will receive an appointment with Dr Bourne in his Rooms the following week to discuss results and further treatment if required.

 

General Risks

• Small areas of the lungs may collapse, increasing the risk of chest infection.  This may need antibiotics and physiotherapy.
  
• Clots in the legs (deep vein thrombosis or DVT) with pain and swelling.  Rarely part of this clot may break off and go t the lungs which can be fatal.
  
• A heart attack because of strain on the heart or a stroke.
  
• Death is possible due to the procedure.
  

Risks or this Procedure

• Bleeding which may require a blood transfusion.
• There is a very rare risk of severe bleeding requiring open exploration of the kidney.  If this occurs, the kidney may have to be removed.
• Septicaemia (blood poisoning). Antibiotics are usually given to help prevent this.
• Very rarely, injury to the bowel.  Further surgery and repair may be required.
• Injury to the pleura (lining of the lung cavity).  This may require a tube to be put into the chest to re-inflate the lung.
• During the procedure, a small fragment of stone may fall into the ureter causing a blockage.  If this happens, a stent (a drainage tube between the kidney and the bladder) may be inserted.
• The aim of the procedure is to either clear the stone completely or break up the stone.  If breaking up of the stone is done, further surgery may be needed to remove other pieces of the stone from within the kidney.
• Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.
• Increased risk in smokers of wound and chest infections, heart and lung complications and thrombosis.
• In some cases it is not possible to gain adequate access to the kidney or to be able to remove the stone at all.

Please notify us or present to the hospital if–

• bleeding persists
• high temperature develops
• bladder irritation continues
• severe abdominal pain