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Percutaneous Nephrolithotomy (PCNL)

What is Percutaneous Nephrolithotomy?

Percutaneous Nephrolithotomy is a minimally invasive procedure which is performed to remove stone from the kidney by inserting a tube through the skin into the kidney (using a Minimally Invasive or 'key hole' approach).

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Where can I get Percutaneous Nephrolithotomy?

Country Cost with MedSolution
India (Please inquire for price)
Cost of procedure performed in the US: $11,000.
All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.

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Why is Percutaneous Nephrolithotomy performed?

Percutaneous Nephrolithotomy is performed to remove stones from the kidney and upper part of the ureter. Only those stones that cannot be treated by Lithotripsy or Cystoscopy / Ureteroscopy due to it's shape (stag-horn shape stone(s) in the renal calyces), very large size, number (multiple stones) or location (deeply impacted in the kidney tissue or upper part of urinary bladder) are treated and removed using Percutaneous Nephrolithotomy. If you have a kidney stone(s) that fulfills all or one of the above criteria, then you are an ideal candidate for Percutaneous Nephrolithotomy.

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Does Percutaneous Nephrolithotomy damage the kidney tissue?

Since Percutaneous Nephrolithotomy is a minimally invasive procedure, some damage to the kidney tissue is inevitable. However, these tears and scars heal quickly after Percutaneous Nephrolithotomy surgery resulting in no significant effect on your kidney function.

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How do I prepare for Percutaneous Nephrolithotomy?

Since Percutaneous Nephrolithotomy is performed under general anesthesia, you will be instructed not to eat or drink anything at least 10 hours before the operation. Drink only clear fluids for a 24 hour period prior to the Percutaneous Nephrolithotomy surgery. Before the Percutaneous Nephrolithotomy procedure, a thorough physical examination and diagnistic tests will be performed to determine the number, location, and size of the stone(s). A diagnostic test called an Intravenous Pyelogram (IVP), is used to locate the stone(s). An IVP is a procedure in which a radio-opaque dye is injected into a vein in the arm. This dye will show up on x-ray as it travels through the bloodstream and reaches the kidney to be excreted with urine. The dye flows down the ureter and into the urinary bladder. The radio-opaque dye surrounds the stone(s) and will appear on the x-ray as dark shadows or filling defects. Before the IVP test, make sure that your physician rules out any allergies to the dye. Stop smoking and do not take aspirin to prevent bleeding problems from occuring. Make sure that you are not pregnant or have heart disease before going in for Percutaneous Nephrolithotomy procedure.

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What does Percutaneous Nephrolithotomy involve?

Percutaneous Nephrolithotomy is performed under general anesthesia and may take about 3 - 4 hours. An incision in the skin, about 1/2 inch in length is made in the flank area, overlying the kidney. A thin tube (nephrostomy tube) is passed through the incision under x-ray guidance to visualize the stone. A Lithotripter is used to break the stone and the stone fragments are then removed through the tube. The nephrostomy tube is left in the kidney to allow easy drainage of urine, blood and residual fragments of stone. A stent may be placed to ensure patency of the ureter and facilitate drainage from the kidney to the urinary bladder. A catheter will be placed to drain urine from your urinary bladder.

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What is the recovery period like following Percutaneous Nephrolithotomy?

You will spend the next few hours in the recovery room under observation for immediate post-operative complications after Percutaneous Nephrolithotomy. Avoid constipation and drink plenty of water and clear fluids to make it easy to urinate. The nephrostomy tube and urinary catheter will be removed on second post-operative day and you will be allowed to go home at that time. You will notice blood in your urine for the next several days which will gradually clear away. On the first post-operative day, make an effort to walk around a little to prevent clot formation in the leg veins. You will have to monitor your urine output, color and odor very closely at home and also care for the nephrostomy site. Clean the area around the insertion site with mild soap and water every day when you shower. Pat the area dry, clean directly around the insertion site with hydrogen peroxide using a cotton tip applicator and apply a clean sterile dressing after cleaning the area. The stent will be removed after 2 - 6 weeks in the doctor's office.

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What is the outcome of Percutaneous Nephrolithotomy?

Percutaneous Nephrolithotomy successfully and effectively removes large and abnormal shaped (stag-horn) kidney stones. Percutaneous Nephrolithotomy is usually performed in combination with Lithotripsy so that the small stone fragments and debris can be urinated out. Follow up 'second look' will be taken to make sure that all the stones are removed. Repeat Percutaneous Nephrolithotomy procedure is seldom needed.

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B . R . A . N . D . of Percutaneous Nephrolithotomy

Benefits of Percutaneous Nephrolithotomy

  • Large and abnormally shaped stones can usually be removed in one sitting, short hospitalization and less recovery time. You can return to your normal daily activities in a couple of weeks.

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Risks of Percutaneous Nephrolithotomy

  • Failure of the procedure - Failure to remove the stone(s) in the first attempt may warrant a repeat Percutaneous Nephrolithotomy procedure.
  • Excessive bleeding
  • Hematoma formation
  • Infection - Infection may develp at the Percutaneous Nephrolithotomy site or in the urinary tract.
  • Injury and perforation of the bowel

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Alternatives to Percutaneous Nephrolithotomy

  • Lithotripsy - Extracorporeal Shock Wave Lithotripsy (ECSWL) or Intracorporeal Shock Wave Lithotripsy (ICSWL)
  • Open surgery - This method is rarely used now for stone extraction. It may be required if the stone has damaged the kidney so badly that the kidney must be removed with the stone. Very large stones in the ureter may also be treated by open surgery.

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Now or Never

  • All kidney stones have some potential to damage the kidney tissue and resuce kidney function. If a stone is left blocking the ureter for some time progressive dilatation of the kidney occurs due to back pressure. This leads to a loss of kidney tissue, if infection presents with an obstructing stone then kidney damage can be severe and sudden.

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Decision to have Percutaneous Nephrolithotomy

  • With the advent of newer and sophisticated equipment, Minimally Invasive Surgical Techniques are becoming increasingly popular. As there are several treatment choices available, each kidney stone can be approached differently. The availability of equipment and expertise of your surgical team at the medical facility often dictates which operation(s) will be performed.

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Keywords: Kidney Stones, Bladder Stones, Cystitis, Urinary Tract Infection, Hematuria (Blood in urine), Urethral Stricture, Ureteroscope, Prostate Enlargement, Cystoscope, Intravenous Pyelography (IVP), Urinary Incontinence, Overactive Bladder, Urinalysis, Bladder Catheter, Kidney Operation, Painful Urination, Pelvic Pain, Iinterstitial Cystitis, Urinary Blockage, Narrowing of the Urinary Tract, Stone in the Urinary Tract, Bladder Cancer, Bladder Biopsy, Kidney Tumor, Minimally Invasive Procedure

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