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PCNL / Percutaneous Nephrolithotomy

If one has larger kidney stones and other methods of kidney stone removal are not working, such as extracorporeal shock wave lithotripsy, then the urologist recommends a Percutaneous Nephrolithotomy (PCNL) procedure.

It is one of the best and minimally invasive surgical (keyhole procedures) techniques with lower risk. The doctors and kidney stone experts in Hyderabad at Arete Hospitals are expertly trained to perform this procedure. This procedure is typically reserved for the management of large kidney stones.

Arete Hospitals is known as the best kidney stone removal hospital in Hyderabad, Telangana, and offers state-of-the-art technology, expertise, and successful surgical outcomes and at the hospital patient safety is kept at a premium priority. 

Benefits of Percutaneous Nephrolithotomy / PCNL Surgery

PCNL operation and shock wave Lithotripsy have revolutionised the treatment of kidney stones. Benefits of this surgery are: 

  • Kidney stones larger than 1.5 cm or bigger can be removed with this procedure
  • Remove kidney stones that cannot be removed from other methods
  • Surgery is minimally invasive
  • The healing period is quick compared to open surgery
  • Expect a 90% stone-free rate with PCNL
  • Offers precise localization of the stone
  • Minimal trauma to the kidney and surrounding organs
  • Treating and removing large stone burdens in a single setting.

What is Percutaneous Nephrolithotomy / PCNL?

PCNL is a minimally invasive procedure for kidney stone treatment in Telangana. Percutaneous means through the skin, and Nephrolithotomy means the removal of kidney stones. The majority of kidney stones are removed from the kidneys using the shock wave machine. Larger stones cannot be treated using shock waves and require the help of PCNL or an operating telescope.  Then the further stone is broken up using the shock wave, removing the fragments.

Before Percutaneous Nephrolithotomy / PCNL Surgery

When the kidney stones are visible on the X-ray, then one is recommended for PCNL. Then a blood test is performed, and a urine sample is taken 4-5 days before the surgery. An X-ray is again performed before the surgery to check the location of the stone. If the patient is above 60 years of age or with other health concerns, then an electrocardiogram is performed to check heart health before the surgery.

On the operation day, the patient is advised to stop eating and drinking before surgery. On arrival, the ward staff will guide the patient through what is required before the surgery. Then the anesthesiologist will see the patient before the operation. Before the surgery, the patient will be given a tablet to help them relax.

What does Percutaneous Nephrolithotomy / PCNL surgery involve?

Percutaneous Nephrolithotomy Procedure

  • The procedure takes between 1-3 hours to complete.
  • This procedure is performed under general anaesthesia, and the patient is completely asleep.
  • In this surgery, the doctor makes a small incision in the patient's back area that is 1 cm or less. This incision allows access to the back area. A contrast dye goes up the tube to visualise the kidney using X-rays.
  • Then a kidney stone surgeon in Hyderabad inserts a protective sleeve to reach the kidney. Through this sleeve, a miniature tool is inserted to remove the kidney stones, using X-ray guidance.
  • This allows doctors to have access to the kidney. This helps them identify the location of the kidney stones with the help of a nephroscope (small fibre-optic camera). Then the shock wave device breaks down the large kidney stones into smaller pieces. These kidney stones are removed through the small incision at the back area.
  • After the patient wakes up, they will have a small tube draining urine from the kidneys into that bag. This urine is usually bloody similar to the colour of fruit punch. This is usually removed the next day, and the catheter in the patient's bladder will also be removed. One can go home the day following the surgery or after 2 days (depending on case to case).
  • In certain cases, a temporary internal stent is placed between the kidney and bladder to help heal. In some patients, this stent can cause increased urination, blood in the urine, and discomfort in the flank area. The internal stent is removed during a follow-up visit.
  • The urologists in Hyderabad at Arete Hospitals are highly experienced in treating and managing large and complex kidney stones with PCNL and other advanced techniques.

Kidney stone doctors in Hyderabad perform PCNL surgery at the urology department at Arete Hospitals, and complications are unusual. The most common problem is infection, and the patient will routinely receive antibiotics and proper care to prevent this from happening.

Good Candidates for Percutaneous Nephrolithotomy / PCNL

This is the best option for people with large kidney or ureteral stones (> 2 cm), multiple big stones, or stones that are resistant to prior treatment like ESWL or ureteroscopy.

Not good candidates for Percutaneous Nephrolithotomy / PCNL

Patients with: 

  • Severe heart or lung conditions
  • Uncorrectable bleeding propensity
  • Active urinary infection
  • Higher risk of sepsis.

After Discharge

  • One must go for a follow-up appointment after 6 weeks of the operation.
  • It will take about 2 weeks to recover fully from the operation, and one must return to work after 10 days, especially if the job is strenuous.
  • When the patient goes home, they must drink double as much water as they normally drink to flush the system through and to minimise bleeding.
  • One must try to keep urine colourless to decrease the risk of further stone formation.
  • The patient must avoid heavy lifting or pulling for 2 to 5 weeks after surgery.

Cost of Percutaneous Nephrolithotomy / PCNL Surgery in Hyderabad

Typically, as it is a medical procedure, and the cost is covered by most insurances (although deductibles and coinsurance one have to pay). Our team of experts at Arete Hospitals will verify the coverage properly before proceeding with the surgery. If one does not have insurance, then our experts will give one the cost estimate of the surgery.

Effectiveness of Percutaneous Nephrolithotomy / PCNL Surgery

For removal stones greater than 2cm, PCNL is the first line of management. With this surgery option, the stone-free rate is higher, making it also an effective option for stones that are 1.5 cm in the lower part of the kidneys.

Risks Associated with Percutaneous Nephrolithotomy / PCNL

The Common Risks Can Include

  • Urinary tract infection that requires antibiotics
  • Catheter insertion in the bladder (temporary)
  • Blood in the nephrostomy drain or urine
  • Formation of new stones over the next 10 years that require further management

Rare Risks

  • Injury to other organs and even kidneys
  • Heavy bleeding from the kidneys that require intervention to stop
  • infection at the site of the incision

Occasional Risks

  • Sepsis (requires antibiotic treatment)
  • Formation of residual stones that require further treatment/surgery.
Frequently Asked Questions

1. How to prevent kidney stones from reforming?

The best advice is to drink enough water and maintain dilute urine, especially during warm weather conditions. One would produce at least 2 litres of urine per day.

When the doctor determines the root cause of the formation of stones, they provide more specific advice regarding medical treatment to prevent stone recurrence.

2. What are the other treatment options for removing kidney stones?

  • Ureteroscopy
  • Partial nephrectomy
  • Nephrectomy
  • Shock wave lithotripsy (ESWL)

3. Can multiple stones be treated simultaneously with PCNL?

Yes, multiple stones can be treated with PCNL. This is one of the greatest benefits of this surgery, and to achieve this flexible telescope is passed through the skin and directly into the kidney to identify and remove multiple stones in one setting.

Sometimes, it may be difficult to visualise all stones despite the use of flexible telescopes, and some stones may need to be retrievable. This requires the placement of a second needle tract to access the remaining stones, or a second PCNL procedure is performed later. 

Instead, PCNL can be used to remove most of the stone burden with ureteroscopy and ESWL, which helps remove remaining stone fragments.

4. What is the overall success rate with PCNL?

The success of surgery is determined based on various factors like the composition of the stone, size of the stone, number of stones, location, patient body health (obesity), and anatomy of the kidney.

The surgeons at Arete Hospitals, the best urology hospital in Hyderabad, Telangana, cautiously consider all of the factors above and discuss this with the patient to maximise success and determine if PCNL is right for you.

5. How do I know if PCNL was successful?

Following the surgery, the surgeon will determine whether the treatment was successful based on a CT scan performed on the first postoperative day. If the fragments of the stones remain in the urinary tract, the surgeon may recommend further treatment with repeat PCNL, ESWL, or ureteroscopy.

6. Can PCNL be performed on both of my kidneys at the same time?

If the patients have a large stone in both kidneys, in such a case, bilateral PCNL, surgeries are performed that are staged at a later date as two separate surgeries. The surgeon makes this decision.

7. Will I be hospitalised for this procedure?

Yes. This procedure necessitates the use of general anaesthesia and typically requires a short hospital stay of 2 to 3 days. Recovery time may extend to a week, and the duration of the procedure ranges from 20 to 45 minutes, depending upon the stone’s location. The primary goal is to remove all stones to prevent any remaining ones from traversing the urinary tract.

If one is experiencing pain in the flank area and suspect they have kidney stones, then book an appointment with the kidney stones doctors in Hyderabad at Arete Hospitals. The doctors are board-certified urologists trained to find and provide the best solution to remove kidney stones.

These surgical procedures always have small risks or complications, but if they occur, the hospitals have all the facilities and expertise to deal with them. Most patients staying at Arete Hospitals have a trouble-free stay and make a quick recovery.

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