What is Percutaneous Nephrolithotomy (PCNL)?

It has been a perfect and minimally invasive surgery called percutaneous nephrolithotomy, specifically done for removing large and complex kidney stones, which are unresponsive to drug therapy or even to shock wave lithotripsy (SWL). It requires a small incision to be made in the rear to access the kidney and remove the stones directly. Stones greater than 2 cm or those resistant to other treatments, such as staghorn calculi, have been the gold standard.

Why PCNL Should Be Done?

When it comes to large stones (greater than 2 cm), irregular, or both, staghorn stones occupying a large part of the kidney and obstructing urine flow, leading to hydronephrosis, these are other indications for PCNL. Other indications that warrant PCNL include severe or recurrent infections related to kidney stones and failure or non-authorisation of different treatments like ESWL or ureteroscopy. Otherwise, untreated stones can cause kidney damage and infections, in addition to severe pain.

Before the Procedure

Preparing should include:-

Imaging tests: such as CT or IVP. CT or IVP helps to assess stone size, location, and the anatomy of the kidneys.
Blood and urine tests: evaluation of kidney function and infection-free status.
Medication review: the patient should disclose all blood thinners or medications they currently take.
Infection control: Antibiotics may be an option if there is evidence of infection.
Fasting - Usually required 6-8 hours before the procedure.

What Should I Expect During the Procedure?

Anaesthesia: PCNL works under general anaesthesia.
Positioning: You're placed on your stomach (prone position).
Incision Access: Incision (abdominal incision of < 1.0 cm) performed on the back for the kidney.
Taking Tract Dilatation and Nephroscope: Hollow tube using nephroscope for the image moves into the kidney.
Stone Fragmentation and Removal: The stones break down using ultrasonic, pneumatic, or laser energy, disappearing completely.
Drainage Tube: A nephrostomy tube is placed temporarily for urine drainage.
Duration: Generally, two to three hours, depending on complexity.

Post-Procedure Care

Hospital Stay: Normally, 2-3 days to monitor and manage drainage.
Catheter & Nephrostomy Tube: These can remain in place for 24-48 hours.
Pain Control: Mild discomfort at the incision site would be considered normal; analgesics would be the best medicine.
Hydration: Adequate oral intake to eliminate the remaining fragments.
Follow-Up Imaging: To prove complete stone clearance.
Return to Routine: Most patients return to regular activities after 10-14 days.

Benefits of PCNL

Effective for Large or Complex Stones: High level of success for staghorn calculi.
Minimally Invasive: Unlike open surgery, the smaller incision offers less invasion.
Quicker Recovery: Shorter wait to resume normal activities.
Reduce Number of Procedures Required: Usually, it can remove all stones in one visit.

Risks & Possible Complications

PCNL, which often seems relatively safe, is not without risk:-

Bleeding (may, in rare cases, require transfusion)
Infection or fever
Injury to the kidney or nearby organs (rare)
Residual fragments of stone
Further secondary procedure is necessary in case of remaining stones

Precautions after Surgery:

Drink not less than 3 litres of water daily.
Consume regularly the prescribed antibiotics and other medicines.
Don't lift heavy objects and avoid strenuous activities for two to three weeks.
Watch urine colour and report immediately if there is persistent bleeding or pain.
Keep the appointment for follow-up visits, as advised.

Is PCNL Painful?

The whole procedure is under general anaesthesia, which means that it is painless while under anaesthesia. A minor soreness around the incision site will be there afterwards, but it will be temporary.

Will I need a second procedure?

PCNL can often remove the stones in one sitting, but complex cases may require more procedures.

For how long will the drainage tube remain?

Generally, it is between 24 and 48 hours according to the healing and the amount of urine output.

Can stones come back after PCNL?

Reformation is possible without preventive services, and changes in diet and lifestyle behaviour are significant.

Why Choose Tender Palm Super Speciality Hospital for Percutaneous Nephrolithotomy (PCNL) in Lucknow, India?

Tender Palm Super-Speciality Hospital is one of the best hospitals for Percutaneous Nephrolithotomy (PCNL) in Lucknow, India. Our experienced Urologists uses advanced technology, and provides patient-focused care, the hospital ensures safer procedures, quicker recovery, and improved long-term outcomes.