What you need to know about:

Percutaneous Nephrolithotomy (PCNL)

Fast Fact

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Average Cost:

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Recovery Period:

1-2 nights in hospital

Permanence:

Depends on patient condition

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Doctors

Time it takes:

1-3 hours

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Anesthetize:

General Anesthesia

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Overview of

Percutaneous Nephrolithotomy (PCNL)

in Thailand

Percutaneous nephrolithotomy (PCNL) is a procedure to remove medium-sized to large-sized kidney stones (stone with a diameter of more than two centimeters) using a scope that is inserted through a small incision in the back.

Goals of

Percutaneous Nephrolithotomy (PCNL)

If your stone is unusually large, your doctor may not be able to get it out through other surgeries that use shockwaves or lasers. As such, a percutaneous nephrolithotomy may be a good alternative if: -Your stone is about 4/5 of an inch in diameter (the size of a nickel) or bigger -You have a lot of them, or they’re very dense -You have branched stones called staghorn that block a large part of your kidneys -You’ve had other treatments without success

Price of

Percutaneous Nephrolithotomy (PCNL)

Average Cost

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Price Range

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Pros and cons of

Percutaneous Nephrolithotomy (PCNL)

Pros

-PCNL is one of the most effective techniques for making sure a patient is stone-free. Most patients leave the hospital stone free. Occasionally, though, another procedure will be needed to remove a stone.

Cons

-Even though it involves an incision, it is less invasive than a full open surgery to treat the kidney stone. Because it is among the more difficult surgeries, it is performed by surgeons with specialized training. Urologists and radiologists may work together on these surgeries.

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How it works:

Percutaneous Nephrolithotomy (PCNL)

Because percutaneous nephrolithotomy is done using general anesthesia, the patient will need to be assessed for any risks associated with the procedure. Once you pass the assessment you will receive anesthesia that will put you to sleep. The doctor will use a fluoroscope to determine the site for the insertion of the scope and make a small incision, about one centimeter in length, in your back. This allows the doctor to insert the nephroscope into the kidney. When the doctor finds the stone, they will break it up into smaller pieces using a small tool called a lithoclast lithotripsy before removing them through the incision. The doctor may also turn the stones into sand-like particles and remove it using ultrasonic lithotripsy. The PCNL procedure usually takes 1-4 hours depending on the size, number of stones and their location.

Preparation before

Percutaneous Nephrolithotomy (PCNL)

Pre - treatment

Percutaneous nephrolithotomy is done using general anesthesia so patients must undergo a thorough health screening before the procedure. This may include blood tests as well as tests to assess the functions of the heart and lungs to ensure you are healthy enough for both the general anesthesia and the procedure. You must avoid food and water for at least eight hours before the procedure. You will have to stop certain medications before the procedure, especially any that affect coagulation, such as aspirin. Please let the doctor know about all medications, supplements, and herbs that you are taking. Please let the doctor know about any allergies you have to medication, latex, and anesthesia, as well as any history you have of abnormal bleeding. If you suspect that you might be pregnant, please let your doctor know immediately

Recovery after

Percutaneous Nephrolithotomy (PCNL)

Post - treatment

After the procedure you will be monitored closely by nurses until you are fully awake from the anesthesia. You will stay in the hospital for about three to five days. On the first day you may feel some pain at the incision site. You can take the prescribed pain medication. After the procedure you will have a catheter in the incision to drain urine. It will be removed after two to three days. Monitor the color of your urine. It may be red or dark in color. This will improve within a day or two. Drink at least three to four liters of water each day to help flush out any remaining pieces of the kidney stones. You can return to normal activities after one week. You can exercise after one month.

Risks & side effects

Infection: Before the procedure all patients will receive antibiotics to prevent infection. If you show signs of infection, such as high fever, pus at the incision, frequent urination or difficulty urinating, and/or severe pain, please let the doctor know immediately. Bleeding: Excessive blood loss is possible during the procedure, but this is rare. In some cases the patient will require a blood transfusion. Problems with the function of the kidneys after the procedure, adhesions that occur in the kidneys or ureters. Open surgery is needed instead, which is rare, due to the kidney stone being too big or being in a location where it cannot be removed.

FAQs:

Percutaneous Nephrolithotomy (PCNL)

What are the recommendations for travel for this procedure?

If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure. Travelers to Thailand should plan to stay in the country for at least two to five days after the procedure, depending on their condition after surgery, or for the entire duration of treatment. If you plan to return home after the procedure, please speak to your doctor before making travel arrangements. There are no restrictions for air travel. During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).

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What causes kidney stones?

Kidney stones often have no definite, single cause, although several factors may increase your risk. Kidney stones form when your urine contains more crystal-forming substances — such as calcium, oxalate and uric acid — than the fluid in your urine can dilute. At the same time, your urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.

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How long will it take to recover from this procedure?

Most patients take approximately 1-2 weeks to fully recover after the procedure

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What are the different types of kidney stones?

Knowing the type of kidney stone you have helps determine its cause, and may give clues on how to reduce your risk of getting more kidney stones. If possible, try to save your kidney stone if you pass one so that you can bring it to your doctor for analysis. Types of kidney stones include: Calcium stones. Most kidney stones are calcium stones, usually in the form of calcium oxalate. Oxalate is a substance made daily by your liver or absorbed from your diet. Certain fruits and vegetables, as well as nuts and chocolate, have high oxalate content. Dietary factors, high doses of vitamin D, intestinal bypass surgery and several metabolic disorders can increase the concentration of calcium or oxalate in urine. Calcium stones may also occur in the form of calcium phosphate. This type of stone is more common in metabolic conditions, such as renal tubular acidosis. It may also be associated with certain medications used to treat migraines or seizures, such as topiramate Struvite stones. Struvite stones form in response to a urinary tract infection. These stones can grow quickly and become quite large, sometimes with few symptoms or little warning. Uric acid stones. Uric acid stones can form in people who lose too much fluid because of chronic diarrhea or malabsorption, those who eat a high-protein diet, and those with diabetes or metabolic syndrome. Certain genetic factors also may increase your risk of uric acid stones. Cystine stones. These stones form in people with a hereditary disorder called cystinuria that causes the kidneys to excrete too much of a specific amino acid

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