Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm
CPT4 code
Name of the Procedure:
Percutaneous Nephrostolithotomy or Pyelostolithotomy (PCNL)
Summary
Percutaneous Nephrostolithotomy or Pyelostolithotomy (PCNL) is a minimally invasive procedure to remove kidney stones that are up to 2 cm in size. The procedure involves accessing the kidney through a small incision in the back, breaking the stones into smaller pieces using various techniques, and removing them.
Purpose
This procedure is designed to remove kidney stones that are too large to pass through the urinary tract on their own, or that cannot be treated effectively with other less invasive procedures. The primary goal is to relieve pain, eliminate infection risk, and prevent kidney damage by clearing the obstruction.
Indications
- Kidney stones larger than 2 cm
- Stones causing severe pain or infection
- Stones that have not responded to other treatments like shock wave lithotripsy
- Recurrent kidney stones causing ongoing urinary tract issues
Preparation
- Fasting for at least 6-8 hours before the procedure
- Adjustment or discontinuation of certain medications (e.g., blood thinners)
- Blood tests and imaging studies (e.g., CT scan, ultrasound) for precise stone location and size
- Possible use of antibiotics to reduce infection risk
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A small incision (~1cm) is made in the patient's back.
- Accessing the Kidney: A nephroscope is inserted through the incision to reach the kidney.
- Fragmentation and Removal: The stones are broken into smaller pieces using tools like lithotripters (ultrasonic waves, lasers) and extracted using baskets or forceps.
- Stenting (if needed): A stent may be placed to ensure the urinary tract remains open post-procedure.
- Drainage: A nephrostomy tube may be left temporarily to drain urine from the kidney.
Duration
The procedure typically takes 1 to 3 hours, depending on the size and number of stones.
Setting
PCNL is generally performed in a hospital's operating room or a specialized surgical center.
Personnel
- Urologist or specialized surgeon
- Anesthesiologist
- Surgical nurses
- Radiologic technologists (if imaging guidance is required)
Risks and Complications
- Infection
- Bleeding
- Injury to the kidney or surrounding organs
- Urinary leakage
- Reaction to anesthesia
- Residual stones requiring further treatment
Benefits
- High success rate in removing stones
- Relief from pain and urinary obstruction
- Reduced risk of recurrent urinary tract infections
- Preservation of kidney function
Recovery
- Hospital stay for 1-2 days post-procedure
- Pain management with prescribed medications
- Instructions to drink plenty of fluids to flush remaining stone fragments
- Activity restrictions for a few weeks
- Follow-up imaging to ensure all stones are cleared
- Monitoring for signs of infection or complications
Alternatives
- Extracorporeal Shock Wave Lithotripsy (ESWL)
- Less invasive, less effective for larger stones
- Ureteroscopy
- Suitable for stones in the ureter, less effective for large renal stones
- Open surgery (rarely used)
- Considered for complex cases, more invasive than PCNL
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel pain. Post-procedure, there might be pain or discomfort at the incision site, managed with pain medications. Patients may also experience temporary blood in the urine and mild discomfort while urinating. Following recovery instructions will aid in a smoother recovery process, and most patients can return to normal activities within a few weeks.