Percutaneous nephrolithotomy (PCNL)

Need to know

• What happens icon plus

  Percutaneous means through the skin and nephrolithotomy means taking stones out of the kidney. It takes one to two hours and is carried out under general anaesthetic.
  
  Using X-ray guidance, a radiologist passes a surgical telescope (nephroscope) through a small cut in the skin into the kidney to see your stone. The stone is broken into fragments and removed via the nephroscope.
  
  A drain called a nephrostomy tube may be left in the kidney. A fine tube or stent that goes from the kidney down the ureter and into the bladder may also be inserted. The fluid that comes out is initially blood stained but clears in one to two days. A urinary catheter is inserted after the operation.
  

   

• How to prepare icon plus

  You'll need to attend a pre-op assessment to ensure that you are fit enough to undergo surgery. Bring a list of your regular medications with you. You may have blood tests as well as other investigations such as a urine test, electrocardiogram (ECG) or chest X-ray to this appointment.
  
  If you take blood thinning medication, you may need to come into hospital a few days before surgery or switch the you rtablets to an injection for a few days before you are admitted. You'll be receive advise on the best approach.
  
  If you smoke, you may be asked to stop smoking, as this increases the risk of developing a chest infection or deep vein thrombosis (DVT). Smoking can also delay wound healing.

• Afterwards icon plus

  You'll wake up in the recovery room of the operating theatre before being taken back to your floor. You'll have intravenous fluids (a drip) at first but you should be drinking and eating normally the next day.

  The urinary catheter is usually removed with the ureteric tube the morning after surgery. The small nephrostomy tube coming directly out of the kidney also drains urine. An X-ray dye will be injected down this tube on the third post-operative day and if the kidney is draining well, the tube will be removed.

  If the X-ray shows that this is not the case, you'll be discharged with the drain in place. A repeat X-ray will be booked a week later.