PCNL is the most significant of the commonly performed procedures, especially for Renal Stones. It is called Percutaneous Nephrolithotomy (PCNL) and this procedure is certainly the best one for large as well as complex stones. The surgery makes a ½ inch incision in the back of the patient, through which a hollow tube is placed and the tube delivers access to the inside part of the kidney that contains the stone(s). Utilizing a metal telescope, the stones are withdrawn directly or maybe into shattered elements which are eventually to be removed too.
Due to the incision made in the skin along with the tube placed inside the kidney for stone(s) withdrawal, PCNL holds additional danger than the other commonly performed procedures for removing the kidney stones, also the procedure demands an overnight stay within the hospital premises. It cannot be performed with patients having uncorrected bleeding disorders.
Who is a candidate for PCNL?
- PCNL is typically recommended for people with kidney stones that are larger than 2 cm in diameter, or for stones that are located in complex areas of the kidney.
- It may also be an option for people who have had unsuccessful treatment with other methods, such as shock wave lithotripsy or ureteroscopy.
What are the risks of PCNL?
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- As with any surgical procedure, there are some risks associated with PCNL. These include bleeding, infection, and damage to the kidney or surrounding organs.
- However, the risks of PCNL are generally low, and the procedure is considered to be safe and effective.
What is the recovery time for PCNL?
- Most people can go home from the hospital the day after PCNL.
- You may need to take pain medication for a few days, and you will need to avoid strenuous activity for a few weeks.
- Most people make a full recovery within 4-6 weeks.
How long does the procedure take?
A minor procedure typically takes 30 minutes to 1 hour, while major surgeries usually last 1.5 to 3 hours, with variations depending on the patient and type of surgery.
What type of anesthesia is used?
Anesthesia types include general, regional, and local. Selection depends on factors such as the procedure, patient’s age, and medical condition.
What are the success rates of PCNL?
PCNL typically boasts a stone-free success rate of approximately 80-90% after the initial procedure, increasing to 90-100% after a “second look” procedure. Success rates can vary between 71% and 100% depending on factors such as stone location and patient characteristics.
Perez, D., Neeman, B. B.,an, D., Raisin, G., Chertin, B., & Kafka, I. (2023). Ultrasound-guided percutaneous nephrolithotomy (PCNL) success rates in patients with elevated body mass index: A comparative study. Urolithiasis, 51(1), 111. doi: 10.1007/s00240-023-01485-9
According to the article, the PCNL success rate (defined as the percentage of patients who were stone-free postoper) was:
- 87.76 for obese patients (BMI > 30)
- 73.47% for non-obese patients (BMI < 30)
Note that the difference in success rates between the two groups was not statistically significant (p =0.1238).
What are the long-term outcomes of PCNL?
Long-term outcomes of PCNL reveal varied results, including new onset renal insufficiency in 10.6% of cases, hypertension in 34.1%, diabetes mellitus in 23.5%, and ureteropelvic junction obstruction in 3.5%. Additionally, PCNL demonstrates significant improvement in renal function, preservation for up to a 5-year period, and a satisfactory stability or improvement in kidney function for patients with staghorn stones.
