Percutaneous Nephrolithotomy (PCNL) is a minimally invasive surgical procedure used to remove large, complex, or multiple kidney stones that cannot be treated effectively with medication or less invasive methods like ESWL (Shock Wave Lithotripsy) or URS (Ureteroscopy).
During PCNL, the surgeon makes a small incision (about 1 cm) in the back to create a direct passage into the kidney. A nephroscope (a thin tube with a camera) is inserted to locate the stones, which are then broken into smaller fragments using laser or ultrasonic energy and removed safely.
Indications
- Large kidney stones (<2 cm in size)
- Staghorn or complex stones occupying multiple parts of the kidney
- Stones resistant to other treatments
- Multiple stones in the kidney
- Stones causing obstruction or recurrent infections
Procedure Steps
- Anesthesia: The patient is given general anesthesia.
- Access Creation: A small incision is made in the flank or back to access the kidney.
- Nephroscope Insertion: A nephroscope is guided into the kidney through a small tube.
- Stone Fragmentation: The stone is broken into pieces using a laser or pneumatic energy.
- Stone Removal: The fragments are removed using suction or forceps.
- Drain Placement: A temporary nephrostomy tube or stent may be placed for drainage.
Advantages of PCNL
- Minimally invasive (small incision, less pain)
- High stone-clearance rate
- Faster recovery compared to open surgery
- Effective even for large or multiple stones
Risks
- Minor bleeding or infection
- Injury to surrounding structures
- Residual stone fragments (may require minor follow-up procedures)
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