The goal of Cystolithotripsy is to treat urinary bladder stones. With the exception of very large stones, it is a therapeutic alternative that is recommended for practically all bladder stones.
How Is a Cystolithotripsy Administered?
When performing cystolithotripsy, either spinal or general anesthesia is used. The genital area is cleaned and the urethra is lubricated before the patient is initially positioned in the gynecological examination position. To locate the stones, a camera is put through the urethra. The lithotripter is an instrument that is attached to the camera and is used to extract and crush stones into little fragments. A catheter is inserted once the treatment is complete. Constant bladder irrigation is required in cases of hematuria (blood in the urine).
Optical Internal Urethrotomy is a procedure to treat urethral strictures, a medical condition where the urethra becomes narrow.
In What Way Does It Assist?
Surgery normalizes the urine flow and it returns back to normal. Following this surgery, the patients had no trouble urinating at all. There are no incisions or cuts made during this minimally invasive procedure, which uses a laser to normalize the stricture.
How Is It Carried Out?
Actions to do: To confirm the stricture and subsequently ascertain its length and severity, diagnostic testing will be carried out. Urine discharge measurement, urine chemical property testing (for blood or bacteria traces), cystoscopy, and urethral measuring are among the first tests. Ultrasounds or X-rays are also used to assess the stricture clinically.
For more, talk to the Best Urosurgeon In Siliguri.
To remove stones without creating any kidney incisions, RIRS uses a laser and a fiberoptic endoscope, a viewing tube that goes through the urethra and into the kidney. It is done under a spinal, local, or general anesthetic.
Is RIRS Necessary?
Large stones are usually treated using an advanced procedure called RIRS. In most cases, it is the greatest choice for patients whose stones range in size from 10 to 14 mm. RIRS is usually successful in kidney stone removal when shockwave lithotripsy and ureteroscopy fail. It is important to discuss medications prior to starting treatment in order to avoid complications after the surgery.
The urethra is a tube that exits semen from the ejaculatory ducts and urine from the bladder of men. It exits the bladder through your external sphincter, and the perineum (the region between your scrotum and anus).
A Urethral Stricture: What Is It?
A urethral stricture is a constriction brought on by scarring in the corpus spongiosum surrounding the urethra and its lining. Less than 1 centimeter in length to the entire length of the urethra are examples of different types of strictures. Although they can appear anywhere along the urethra, the bulbar area is where they are most repeatedly observed.
Retrograde Intrarenal Surgery, abbreviated as RIRS, is a minimally invasive endoscopic procedure used to treat kidney stones and other conditions within the renal pelvis and ureter. During RIRS, a flexible ureteroscope is inserted through the natural urinary passage, typically via the urethra and bladder, reaching the renal pelvis. Advanced imaging, such as laser or digital scopes, assists in visualizing the stones or abnormalities.
The surgeon can then use laser energy to break down and fragment the stones, enabling their subsequent removal or natural passage. RIRS is known for its high success rates and reduced patient recovery times compared to traditional open surgery, making it a preferred option for certain kidney and upper urinary tract conditions.
Is RIRS done same-day, or will I need to stay in the hospital overnight?
RIRS is usually an outpatient procedure, and patients can return home the same day. However, in some cases, an overnight hospital stay may be recommended.
How long will the laser be inside my kidney, and will it hurt?
The laser lithotripsy procedure usually takes a few hours. After the treatment, you may experience pain, especially if a stent is placed between the kidney and ureter. Most of the pain will likely come from the stent. Complete recovery, including the passing of stone fragments, typically occurs within a week. Anesthetics can cause drowsiness and nausea for several hours after the procedure. Be sure to have someone available to drive you home.
Can I go back to work right after RIRS surgery?
Typically, most patients can resume their normal work activities within a day or two after RIRS surgery. However, strenuous exercise and heavy lifting should be avoided for four weeks following the procedure. It is important to follow post-surgery instructions for a speedy and smooth recovery.
Since they use a laser, is there a risk of burning my kidney during RIRS?
Although RIRS uses a laser for stone fragmentation, it is designed to minimize heat damage to the surrounding tissues, thus reducing the risk of burning the kidney. However, some temporary discomfort may occur during and after the procedure.
What happens if the laser can’t break up all the stones?
If a laser can’t break up all of the stones during treatment, other methods such as shock wave lithotripsy or surgery may be required to remove the remaining stones. These methods involve breaking the stones into smaller pieces or physically removing them from the urinary tract.
Can RIRS treat other kidney problems besides stones?
Yes, Retrograde Intrarenal Surgery (RIRS) can be used for diagnosis and management of tumours within the pelvicalyceal system of the kidney. It is also effective in treating blockages in the ureter such as strictures and PUJ obstruction, and in the diagnosis and treatment of ureteric and collecting system tumors.
How can I prevent future stones after RIRS?
To prevent future stones after retrograde intrarenal surgery (RIRS), make lifestyle changes such as staying hydrated, reducing sodium intake, increasing calcium intake, cutting back on animal protein, avoiding oxalate-rich foods, maintaining a healthy weight, and staying active.
Are there any less invasive options for treating my kidney stones?
Small kidney stones may not require invasive treatment. Drinking water, particularly three quarts a day, can help you pass them. In some cases, a non-invasive treatment like lithotripsy, where the stone is broken up, may be used. However, the choice of treatment depends on the size and location of the stone, and your health condition. Consult a healthcare professional for a comprehensive evaluation.
Will I be knocked out?Will RIRS leave any scars on my back?
RIRS procedure is minimally invasive and involves inserting a flexible ureteroscope through the urinary system, so it does not involve any incisions on the back, preventing scars.
Optical Internal Urethrotomy (OIU) is a medical procedure used to treat urethral strictures. During OIU, a specialized instrument called a urethrotome, equipped with optical fibers and a light source, is inserted into the urethra. This allows the surgeon to visualize the narrowed or obstructed portion of the urethra. Using the optical guidance, the surgeon makes precise incisions to open up the stricture, restoring normal urine flow. OIU is often performed as a minimally invasive approach, avoiding the need for open surgery. This procedure is particularly valuable in managing urethral strictures, which are abnormal narrowing of the urethra that can impede the flow of urine.
Pyeloplasty is a surgical procedure designed to correct an obstruction or narrowing in the renal pelvis, the part of the kidney that collects urine. This obstruction often results from a congenital condition called ureteropelvic junction (UPJ) obstruction or other acquired causes. During pyeloplasty, the surgeon typically removes the obstructed segment and reconstructs the urinary tract to restore proper drainage. This can be achieved through open surgery or minimally invasive techniques such as laparoscopy or robot-assisted surgery. Pyeloplasty aims to enhance urinary flow, alleviate symptoms, and preserve kidney function, making it a crucial intervention for individuals with UPJ obstruction.
Ureterolithotomy is a surgical procedure focused on removing stones lodged in the ureter, the tube connecting the kidney to the bladder. It involves a targeted incision guided by imaging techniques to access and extract the obstructing stone. This intervention is chosen when less invasive methods are not suitable, aiming to swiftly relieve obstruction and restore normal urine flow.
Cystolithotripsy is a specialized procedure tailored for the management of bladder stones. Employing a cystoscope introduced through the urethra into the bladder, the surgeon utilizes a lithotripter to disintegrate the stones into smaller fragments. These fragments are then either irrigated out or removed with additional instruments. Cystolithotripsy not only addresses the stones directly but also mitigates the risk of recurrent complications associated with bladder stones.
Ureteroscopy is a highly adaptable and minimally invasive procedure designed for both diagnostic and therapeutic purposes within the ureter and kidney. A flexible ureteroscope, equipped with a miniature camera, is introduced through the urethra and bladder to access the target area. This allows for direct visualization of the urinary tract, and if necessary, intervention through laser lithotripsy or other tools, providing a precise and effective treatment option for a variety of urological conditions.
Supine PCNL represents a nuanced modification of the traditional PCNL technique, characterized by the patient being positioned on their back during the procedure. This alteration enhances access to certain parts of the kidney and simplifies instrument navigation. Surgeons may prefer the supine position for its advantages in anatomical orientation, facilitating efficient stone removal while maintaining patient comfort and safety.
A procedure called, “pyeloplasty” fixes the ureter – the tube that relates the bladder and kidney to each other. Urologists or general surgeons undertake this inpatient treatment to treat obstruction of the Ureteropelvic Junction (UPJ). It’s likely that after the completion of this procedure, one will have to stay in the hospital for 2 days.
Who requires a pyeloplasty?
Both adults and kids could need a pyeloplasty. There is one newborn with a UPJ blockage for every 1500 newborns. In this case, males are twice as likely as females to have it and if the issue doesn’t get reasonable in the next 18 months for newborns, pyeloplasty becomes a necessity for them.
UPJ blockage can also affect older kids, teens, as well as adults. If a kidney blockage arises, a pyeloplasty may be considered as an essential. For complications, talk to the Best Urologist In Siliguri.
Transurethral Resection Of the Prostate (TURP) is the most typical surgery technique to treat Benign Prostatic Hyperplasia (BPH). Here, a few portions of the prostate get removed that are affecting one’s urine flow. With TURP, some men might happen to face “retrograde ejaculation,”. It is the ejaculation of semen into the bladder.
Talk to the Best Urologist In Siliguri now!
Is TURP right for me?
If you have a benign enlarged prostate that is causing you trouble, including difficulty urinating, frequent trips to the bathroom, or blood in your urine, TURP may be a suitable option for you. This surgery can permanently reduce these problems and improve symptoms significantly. However, before deciding on TURP, it’s vital to discuss other treatment options such as medication and monitoring with a healthcare professional. Additionally, newer nonsurgical options like laser surgery or focused ultrasound are also available and may be worth discussing.
What are the benefits and risks of TURP?
Transurethral resection of the prostate (TURP) offers significant benefits for men with benign prostatic hyperplasia, including:
Improved urinary symptoms: TURP can help reduce the frequency and urgency of urination, troublesome remaining urination, and prolonged urination.
Long-term relief: Studies have shown that TURP can permanently reduce prostate-related problems, signifying a long-lasting solution.
However, TURP also comes with risks such as:
Bladder injuries
Bleeding and blood in the urine after surgery
Electrolyte abnormalities
Infection
Loss of erections
Painful urination
Impotence
Retrograde ejaculation
Urinary incontinence
It’s important to weigh the benefits and risks before deciding to undergo a TURP. It’s crucial to discuss TURP thoroughly with a healthcare professional and consider other treatment options as well before making a decision.
How long does a TURP surgery take?
Transurethral resection of the prostate (TURP) surgery usually takes between 1 to 2 hours. The exact duration may depend on the amount of tissue that needs to be removed. Before the procedure, you will receive anesthesia to prevent pain and sometimes a sleep-like state as well. Once the surgery is completed, you’ll be moved back to the recovery area to rest and monitor your progress.
What is recovery like after TURP?
After a transurethral resection of the prostate (TURP) surgery, most men experience tiredness and a feeling of being under the weather for a week or two. The recuperation process usually takes 3 to 4 weeks, during which heavy lifting or strenuous activities are to be avoided. Additionally, it may take 4 to 6 weeks for full recovery, and it is essential to follow doctors’ guidelines closely to ensure proper healing. During the recovery period, urinary frequency might be noticeable, but it usually improves with time. Depending on the surgical intervention and individual healing rate, some men may experience improvements in urinary difficulty within a few days to several months. It is important to consult a healthcare professional for personalized advice and adjustments to the recovery process as needed.
What tests do I need before TURP surgery?
Before TURP surgery, pre-operative preparation generally involves a thorough evaluation by a healthcare provider. This may include a physical examination, blood tests, an electrocardiogram (ECG), and possibly other tests depending on individual circumstances. Blood tests may check for clotting function, complete blood count, and prostate-specific antigen (PSA) levels. A cystoscopy may also be performed to visualize the urethral tract. Additionally, some patients may be asked to undergo urinalysis to assess ligament stability. It’s essential to consult a healthcare professional to determine the necessary tests and prepare for the surgery, ensuring you’re in good health and well-suited for the procedure.
What medications should I avoid before TURP?
It’s important to inform your healthcare provider about any medications you are taking that may increase the risk of bleeding, such as anticoagulants like warfarin, rivaroxaban, aspirin, or clopidogrel. You may be advised to stop taking these medications several days before your transurethral resection of the prostate (TURP) surgery to prevent heavy bleeding during the procedure. Consult your healthcare professional for specific instructions on when to stop taking these medications based on your individual situation. Additionally, other medications that could affect bleeding or recovery may need adjustments or discontinuation before the surgery, so it’s crucial to involve your healthcare team in your planning process.
What can I expect during the consultation for TURP?
During the consultation, your healthcare provider will discuss the TURP procedure, its benefits, risks, and expected outcomes. You’ll have the opportunity to ask questions, and they will answer any concerns you may have about the surgery. The doctor may also explain specific preparations you need to make before the surgery, such as stopping certain medications, and discuss the recovery process. Consultations typically provide essential information to help you make an informed decision about whether the TURP procedure is appropriate for you. Be sure to bring any necessary medical records and ask clear questions to help you understand the proces
How long will I need to stay in the hospital after TURP?
After TURP (transurethral resection of the prostate), you’ll typically need to stay in the hospital for 1 to 2 days. The length of your hospital stay may vary depending on your individual case and whether any complications arise during or after the surgery. Your healthcare provider will monitor your progress closely and provide guidance on when you’ll be ready to go home. They may order a catheter to be placed to help you urinate while your body heals, and this could affect your discharge timer. In most cases, the catheter is removed within 24 to 48 hours, allowing you to start passing urine on your own. If you have any concerns about your recovery after TURP, you should discuss them with your healthcare provider to ensure a smooth and successful recovery process.
What kind of pain can I expect after TURP?
After undergoing a Transurethral Resection of the Prostate (TURP) procedure, some pain is quite common. Mild to moderate discomfort at the operation site is normal. Pain in the pelvic region, rectum, perineum, or lower abdomen is also possible. Pain may be felt when urinating due to urinary tract healing and the presence of a catheter. You may experience burning sensation while urinating, bladder cramps, and spasms in the bladder. It’s important to take pain relievers as suggested by your healthcare provider to manage discomfort and soreness following the procedure. Most patients report that pain is not a significant problem after TURP. Be sure to follow your doctor’s instructions on managing your pain effectively and ensuring a smooth recovery.
For severe pain that is not manageable with prescribed medications, it’s essential to consult your healthcare provider immediately. Remember not to drive, operate heavy machinery, or make important decisions while taking narcotic pain medications. Make sure to discuss any concerns with your healthcare provider before your surgery.
How long will I have a catheter after TURP?
After a Transurethral Resection of the Prostate (TURP) procedure, a catheter is typically left in place for 24 to 48 hours, or until urination becomes possible again. This allows the swelling caused by the surgery to subside and encourages proper urine flow. The duration may vary depending on individual circumstances, and your healthcare provider will determine the most appropriate time for catheter removal. It’s essential to follow your healthcare provider’s instructions carefully to ensure a successful recovery.
In some cases, early catheter removal may be considered, but this usually depends on the severity of the surgical procedure and individual healing rates. Your healthcare team will discuss catheter removal options with you during your recovery process. For most patients, a catheter is typically removed several days or weeks after the surgery. Generally, urinary retention after TURP gradually improves over several weeks, allowing for improved urinary function and increased control. Each person’s healing process is unique, so it’s essential to consult your healthcare provider for personalized guidance on catheter management after TURP.
What are the signs of infection after TURP?
Following your Transurethral Resection of the Prostate (TURP) procedure, it is essential to monitor for signs of infection. Symptoms may include an increase in pain or discomfort, burning sensation during urination, frequent urination, and blood in the urine. These symptoms could indicate an infection, and you should contact your healthcare team if they persist.
After experiencing TURP, adult males may encounter a urinary tract infection (UTI), which can progress to a severe sepsis if not treated promptly. Studies suggest that around 5-10% of patients develop symptomatic UTIs following TURP. Factors contributing to postoperative infections include the iatrogenic disruption to the urinary tract during the procedure and bacterial colonization around the catheter site. Should you notice any warning signs of an infection, it’s crucial to report them to your healthcare team and follow their recommended course of action.
When can I resume normal activities after TURP?
After TURP, most people experience pain during the first few days of recovery. However, this can vary from person to person. The type and severity of pain that someone experiences can depend on the extent of the surgery and individual healing times. It’s common for people to experience a combination of discomfort in the bladder, rectum, and genitals. Pain medications like paracetamol, ibuprofen, or morphine may be prescribed to help manage this discomfort, but your healthcare provider may also recommend physical therapy or other treatments. It’s important to follow their instructions carefully and not hesitate to seek additional medical attention if necessary. Some postoperative pain can persist for a few weeks, but with time and proper care, the symptoms should become more manageable.
What are the long-term side effects of TURP?
While TURP is generally safe and effective, there are potential long-term side effects. The most common long-term complications include retrograde ejaculation and urinary incontinence. Retrograde ejaculation occurs when semen flows back into the bladder instead of out through the urethra during ejaculation, affecting approximately 65-75% of men who undergo the procedure. Urinary incontinence, also known as loss of bladder control, can occur in a small number of cases, though the exact prevalence is not well established.
Other long-term complications include urethral strictures and bladder neck contractures, which can impact urinary flow and require further medical intervention. In some cases, retreatment may be necessary. The incidence and severity of these complications can vary significantly between individuals, making it essential to discuss any concerns with your healthcare provider.
It is important to remember that every individual’s response to surgery is unique, and some men may experience no long-term side effects or only minor complications. Additionally, advances in surgical techniques and technology continue to improve the safety and efficacy of TURP, reducing the risk of complications. Always consult with your healthcare provider for personalized information about your specific situation and any potential risks associated with TURP.
Are there other treatments for an enlarged prostate?
In addition to medications, surgery, and laser treatments, there are a few other options available for treating an enlarged prostate. One such option is convective water therapy, a relatively new treatment that uses steam to reduce the size of the prostate gland. These treatments are evaluated on a case-by-case basis, with the most suitable options depending on factors such as overall health, likelihood of complications, and the severity of symptoms. It’s important to consult with your healthcare provider to determine the best course of action to manage your enlarged prostate.
It’s worth noting that a combination of treatments, such as medications and surgery, may also be used to manage symptoms and slow the progression of the disease. The National Institutes of Health states that transurethral resection of the prostate (TURP) is often the first choice of surgery for BPH. Other surgical options include minimally invasive laser or robotic procedures to remove parts of the prostate gland. The choice of surgery will depend on various factors, including the extent of prostate enlargement, the individual’s overall health, and personal preference.
What are the pros and cons of other enlarged prostate treatments compared to TURP?
When comparing enlarged prostate treatments, both TURP and HOLEP have their pros and cons. TURP offers good outcomes in terms of improving urinary flow, reducing symptoms, and enhancing quality of life. However, HOLEP is found to be a safer surgical procedure compared to TURP, with less bleeding and potentially better long-term relief of urinary bladder outlet obstruction. On the other hand, TURP can have fewer benefits due to its invasiveness and potential risks than laser treatments like HOLEP. In terms of other surgical approaches, TmLEP and PVP haven’t been scientifically proven to be effective in the improvement enlarged prostate symptoms compared to TURP.
The procedure for larger Kidney Stones is undoubtedly complicated, but it is one of the most efficient ways to treat larger Kidney Stones. The highly specialized procedure is called a tubeless mini percutaneous nephrolithotomy (mini PCNL). This is a minimally invasive surgery that lets doctors remove kidney stones with the help of certain small incisions and this helps the patients with quicker than ever and smoother healing, especially compared to the treatments that were utilized in the history. Get the Best Urology Treatment In Siliguri now!
What is Mini-PCNL and how is it different from traditional PCNL?
Mini-PCNL is a minimally invasive surgical procedure used for kidney stone removal, differing from traditional PCNL its smaller sheath size, typically 14 to 20 F, compared to 24 to 30 F for standard PCNL, resulting in less blood loss, shorter hospitalization, and equal efficacy rate.
How is the procedure performed?
The mini-PCNL procedure is performed through a small incision, typically 1cm, under anesthesia, where a miniaturized nephroscope is inserted through the skin to visualize the kidney stone, and then fragmented and removed through a small sheath.
What type of anesthesia is used for Mini-PCNL?
Mini-PCNL is typically performed under general anesthesia, although regional epidural or spinal anesthesia can also be used, depending on the patient and the surgeon’s preference.
What are the potential risks and complications associated with Mini-PCNL?
The potential risks and complications of Mini-PCNL include bleeding, urinary tract infection, urine leakage from the nephrostomy site, injury to surrounding organs, sepsis, pyelonephritis, and systemic inflammatory response syndrome.
Who is a good candidate for Mini-PCNL?
A good candidate for Mini-PCNL is someone who has a large kidney stone (generally > 2 cm), multiple large stones, or stones resistant to prior treatment, and is unable to pass the stone on their own.
What size and location of kidney stones are best treated with Mini-PCNL?
Mini-PCNL is best suited for treating kidney stones that are larger than 20 mm, stones between 2-3 cm, or multiple large that are resistant to prior treatment, located in kidney or upper ureter.
Are there any medical conditions that would make me ineligible for Mini-PCNL?
Medical conditions such as severe kidney failure, bleeding disorders, or certain heart conditions may make you ineligible for Mini-PCNL. Additionally, individuals with severe kidney damage or those who have undergone other kidney stone removal procedures may not be suitable candidates for Mini-PCNL.
What is the recovery process like after Mini-PCNL?
After Mini-PCNL, you can expect to recover within two to four weeks, during which time you should avoid heavy lifting, strenuous exercise, and take antibiotics to prevent infection. You may need to stay in the hospital for one to two nights, and can return to work within one to two weeks.
How long will I need to stay in the hospital?
The length of hospital stay varies depending on the procedure and individual circumstances, but on average, you can expect to stay in the hospital for 24 to 48 hours after an uncomplicated procedure, and up to several days or even weeks for more complex cases.
What are the restrictions on my activity after the procedure?
After surgery, you should avoid strenuous activities, heavy lifting, and contact sports for 2-4 weeks. Light housekeeping and meal preparation are okay, but excessive exercise, jogging, tennis, and weightlifting should be avoided. You may need to wait 4-6 weeks before resuming normal activities, depending on your procedure and doctor’s advice.
When can I return to work or normal activities?
You can typically resume normal activities within 1-4 weeks after surgery, and strenuous activities like swimming or heavy lifting may take 8 weeks. The exact timeline depends on your procedure, health, and doctor’s advice.
What are the success rates of Mini-PCNL?
The success rates of Mini-PCNL vary from 76% to 100%, with some studies reporting stone-free rates of 83.9% for patients with stone sizes >2 cm and 100% for patients with stones <2 cm.
According to Ferakis, Nikolaos, and Stavropoulos, Marios’ 2015 study ‘Mini percutaneous nephrolithotomy in the treatment of renal and upper ureteral stones: Lessons learned from a review of the literature’, minicutaneous nephrolithotomy (miniPCNL) is a safe and effective treatment option for patients with kidney stones, offering comparable stone-free rates to conventional PCNL, with the advantage of less blood loss and shorter hospital stay.
According to Khadgi, Sanjay, et al’s 2021 study ‘Tubeless mini-percutaneous nephrolithotomy for renal stones larger than 20 mm’, mini-percutaneous nephrolithotomy (mini-PCNL) is an effective and safe treatment option patients with large renal stones (>20 mm), with a stone-free rate of 87.6% and a complication rate of 8.4%.
According to a 2021 paper published in Transl Androl Urol by a team of researchers, mini-percutaneous nephrolithotomy (mini-PCNL) is a safe and effective procedure for the treatment of renal lithiasis in pelvic ectopic kidney, with a rate of 100% compared to 50% for retrograde intrarenal surgery (RIRS), although RIRS is less time-consuming and invasive.
Are there any long-term side effects of Mini-PCNL?
Common complications of Mini-PCNL include urinary tract infection, urine leakage from the nephrostomy site, and transient fever. Postoperative pain, blood in the urine, blood clots, infection, and healing problems are also possible. Long-term effects may include deterioration of renal, especially in patients with preoperative UTI diabetes.
What is the risk of stone recurrence after Mini-PCNL?
The lifetime recurrence rate of renal stones is between 10% and 75%. More than 30% of percutaneous nephrolithotomy (PCNL) patients will experience a stone recurrence over 20-year period. The risk of stone recurrence is high, with some studies demonstrating a recurrence rate of over 50% after PCNL.
What are the alternative treatments for large kidney stones?
Alternative treatments for large kidney stones include natural remedies such as staying hydrated, increasing citric acid intake, limiting foods high in oxalates, and using apple cider vinegar, which contains acetic acid that helps dissolve kidney stones. Other remedies include drinking sugar-free lemon juice, taking magnesium citrate, and using omega-3 fatty acids.
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?
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.
