Name of the Procedure:

Nephrolithotomy; Removal of Calculus
Common Name: Kidney Stone Removal Surgery
Medical Term: Percutaneous Nephrolithotomy (PCNL)

Summary

Nephrolithotomy is a surgical procedure to remove large kidney stones that cannot pass on their own. It involves making a small incision in the back to access the kidney and extract the stone using specialized instruments.

Purpose

The procedure addresses large kidney stones that cause pain, infection, or blockage of the urinary tract. The goal is to relieve symptoms, prevent complications, and restore normal kidney function.

Indications

• Severe pain due to large kidney stones
• Urinary tract infections caused by stones
• Stones causing blockages in the urinary system
• Stones that cannot be treated with less invasive methods like shock wave lithotripsy

Preparation

• Patients may be instructed to fast for 8-12 hours before the procedure.
• Adjustments to medications, particularly blood thinners, may be necessary.
• Preoperative imaging tests such as CT scans or X-rays to determine the size and location of the stones.

Procedure Description

1. Administration of general anesthesia to ensure the patient is unconscious and pain-free.
2. A small incision is made in the back to reach the kidney.
3. A nephroscope (a type of endoscope) is inserted through the incision to visualize the stone.
4. Specialized instruments are used to break the stone into smaller pieces or remove it whole.
5. Any remaining fragments are extracted or washed out.
6. A tube may be placed temporarily to help drain urine from the kidney (nephrostomy tube).
7. The incision is closed with sutures.

Duration

Typically takes 1-3 hours, depending on the size and number of stones.

Setting

Performed in a hospital setting, usually in a specialized operating room.

Personnel

• Urologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Radiology technician (if imaging is needed during the procedure)

Risks and Complications

• Infection
• Bleeding
• Injury to the kidney or surrounding organs
• Urinary leakage
• Rarely, incomplete stone removal requiring additional procedures

Benefits

• Effective removal of large stones
• Relief from pain and urinary symptoms
• Prevention of further complications like infections or kidney damage
• Benefits are often realized immediately after recovery

Recovery

• Hospital stay of 1-2 days is typical.
• Pain management with prescribed medications.
• Instructions for wound care and prevention of infection.
• Avoiding strenuous activities for a few weeks.
• Follow-up appointments to monitor recovery and ensure all stones are removed.

Alternatives

• Extracorporeal shock wave lithotripsy (ESWL): Less invasive but may not be effective for large stones.
• Ureteroscopy: Another less invasive option but limited by stone size and location.
• Medical management: Using medications to try and dissolve smaller stones.

Patient Experience

• Patients will be under general anesthesia during the procedure and will not feel any pain.
• Post-procedural pain is manageable with medications.
• Some discomfort may be experienced while recovering, especially at the incision site.
• Full recovery and return to normal activities typically occur within a few weeks.
• Pain management and comfort measures are provided throughout the recovery period.