Percutaneous removal of kidney stones (PCNL) is keyhole surgery. Under general anaesthetic the stone is removed by passing a small telescope through your side directly into the kidney. The stone is broken up and the fragments are removed.
Before your operation
You have a kidney stone visible on x-ray that is suitable for PCNL. The operation and outcomes will be explained to you by your surgeon. When you feel comfortable that you understand what is to be done and have had all your questions answered you will be asked to sign a consent form. This consent form should be signed by both yourself and your surgeon, and forwarded to the hospital prior to your admission.
A blood test will need to be performed, and a urine sample may need to be taken 4-5 days prior to surgery. Your surgeon will give you a form to take to the laboratory to have these tests done.
An x-ray may be performed just before your surgery to check the position of your stone.
If you are over 60, or have other medical problems, you may also have an electrocardiogram (ECG) to check the health of your heart prior to surgery.
Operation day
You will be advised when to stop eating and drinking before surgery. You should bring all your own medications with you to hospital.
On arrival to the ward the staff will show you to your bed and guide you through what is required prior to your operation.
This operation is performed under general anaesthesia. The anaesthetist will see you before the operation. Just prior to surgery you may be given a tablet to help you relax.
You will have protective stockings fitted.
The operation
First, a small tube is inserted up the ureter (tube from kidney to bladder) by means of a telescope passed into the bladder.
You are then turned face down (on your stomach) and a small (keyhole) incision is made into the kidney, using x-ray guidance. Sometimes you will be on your back.
Finally, a telescope is passed into the kidney. The surgeon locates and removes the stone by breaking it into pieces using laser or ultrasound.
When you wake up you will have a small tube coming from your kidney draining the urine into a bag. This is usually removed the next day. You will also have a catheter in your bladder draining urine. This will also be removed the next day. You will usually go home the day following your surgery.
After discharge
You will receive a follow up appointment for 6 weeks after your operation.
It may take at least 2 weeks to recover fully from the operation. You should not expect to return to work within 10 days, especially if your job is physically strenuous.
You can usually resume driving when you feel that you could perform an emergency stop without being concerned about pain (usually about two weeks).
When you get home you should drink twice as much as you would normally to flush your system through and minimise any bleeding. You should aim to keep your urine permanently colourless to minimise the risk of further stone formation.
Complications
All procedures have a potential for side effects. You should be reassured that although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.
- It is common to have blood in the urine
- Occasionally more than one puncture site (keyhole) is required into the kidney
- Sometimes, not all stones are able to be removed from the kidney
- It may not be possible to gain access to the kidney, resulting in the need for a different type of surgery such as ureteroscopy or lithotripsy