For Large Kidney Stones
Keyhole Surgery (PCNL) is a well-established procedure by which stones in the kidney or the upper
ureter are removed by making a small incision in the flank. Generally, an incision,
that is 1 cm or less than 1 cm, is made in the flank. A guide wire is passed through
this incision into the kidney. Keyhole Surgery is performed under fluoroscopy or x-ray control.
A passage is then created around this guide wire by dilatation. Through this passage,
a nephroscope is passed into the kidney to visualise the stone and remove it.
Larger stones can be fragmented by different methods and removed. Stones are
therefore cleared easily. Once the procedure is complete, a tube is left through
this tract as drainage for one or two days.
Advantage & Other notes:
The main advantage of this approach is that, unlike traditional open surgery,
only a 1 cm incision is made in the flank. The stones can be visualised directly
and removed. Unlike ESWL or ureteroscopy, the stones are removed in the same sitting
and the kidney is cleared of calculi. The stay in the hospital is only for 3-4 days.
This surgery would be recommended as a treatment of choice, if the patient has kidney stones larger than 2 cm
This procedure is commonly performed under general anaesthesia, and therefore you also need to be admitted to the hospital for this procedure.
The success rate of clearance of stones with this procedure ranges between 90 to 95%. This actually depends upon the size, number and location of these stones. Sometimes, complete clearance may require a second procedure after a few days.
For the post-operative course, the patient will generally need to stay in the hospital for 2 to 3 days after the procedure. He or she will also undergo additional x-rays or ultrasound studies, to determine if there are any residual stone fragments present.
From the site of the puncture, the patient will have a drainage tube and a urethral catheter, for a day or two. Following the removal of the flank drainage tube, urine may leak for a day.
By and large, this procedure is safe. Some risks that can be associated with all surgical procedures are the possibilities of bleeding (1%) and infection, sometimes requiring blood transfusion.
Some patients have prolonged leakage of urine from the flank site, requiring ureteric stenting. Fever, if present, will require a change in antibiotic.
Rare complications include persistent uncontrolled bleeding due to arteriovenous malformations or pseudo-aneurysms (0.4%), which would need secondary procedures. When a supracostal puncture (above the 12th rib) is made, complications would then include pneumothorax (commonly called collapsed lung caused due to the accumulation of air or gas in the space surrounding the lungs) or fluid accumulation in the thorax. Again, the incidence of these is only 0-4%.
The time by which a patient can get back to work would depend upon the magnitude of the stone burden and the number of tracts made. Most patients return to average activity levels within a week or so. A return to vigorous activity should probably take place after 4 weeks.
The contraindications to this procedure are bleeding disorders and pregnancy (due to the risk of radiation). The others are medical problems making the patient unsuitable for anaesthesia.
Separate and specific changes in the diet may be suggested in case of other conditions associated with urinary stones.
- 1 cm Incision
- Larger Kidney Stones
- High Success rate
- 2 to 3 days clinic rest
- Anesthesia applicable