kidney stone surgery through the back

(Percutaneous Nephrolithotomy)

A scope is inserted through a small incision in your back to remove the kidney stones. With this surgery, your doctor uses a small scope, along with instruments to pluck or vacuum the stones, through a small cut in your back. It’s sometimes also called percutaneous (through-the-skin) nephrolithotomy or stone extraction.

When Percutaneous nephrolithotomy typically recommended?

Large kidney stones are blocking more than one branch of the collecting system of the kidney (known as staghorn kidney stones)

Kidney stones are larger than 0.8 inch (2 centimeters) in diameter
Large stones are in the ureter
Other therapies have failed

Before you undergo percutaneous nephrolithotomy, your doctor will perform several tests. Urine and blood tests check for signs of infection or other problems, and a computerized tomography (CT) scan determines where the stones are in your kidney.

Before Percutaneous Nephrolithotomy

Before the procedure, your surgeon may have you go to the radiology department, where a radiologist will use CT, ultrasound or X-ray imaging to guide access to the kidney. This is done with a local anesthetic, meaning you will be awake but will not feel any pain. You will then be transferred to the operating room for the actual procedure.

Alternately, your surgeon may prefer to access the kidney in the operating room while you are under general anesthesia. In this case, the surgeon will put a tube through your bladder and up into your kidney, and will use X-ray imaging to make a puncture in your kidney so that the stones can be removed. If you have very large stones, the surgeon may need to make more than one puncture.

During the Percutaneous Nephrolithotomy

Before the procedure, your doctor will test your urine and blood for infection. You’ll also have a CT scan, ultrasound, or X-ray so she can see exactly where the stones are.

The surgery usually lasts an hour or two. You’ll lie face-down on a surgical table. You’ll have general anesthesia, so you won’t be awake or feel any pain. Your doctor will inject your bladder with a dye or carbon dioxide so she can “map” the branches of your kidney through a scope.

Then the doctor make a small cut midway down your back on the side with the stones. after that the doctor will insert a fiber-optic camera to peer in. She’ll either remove the stones, or she'll use a laser, ultrasonic, or mechanical device to break them up first. When your stones are crushed before removal, it’s called nephrolithotripsy.

You may leave surgery with a small stent that keeps the tube between the kidney and the bladder open to help with urine drainage. You may also have a tube coming from your incision that helps drain fluid from your kidney to a bag attached to the outside of your body. Your doctor will remove it after 1-2 weeks.

You’ll usually need to stay in the hospital for 1-2 days. You may be able to go back to work about a week after. But you’ll have to avoid heavy lifting or pulling for up to a month.

Aftercare of Percutaneous Nephrolithotomy

You may stay in the hospital for one or two days after the procedure. Your doctor will recommend that you avoid heavy lifting, and pushing or pulling for two to four weeks. You may be able to return to work after a week.

If the doctor has left drainage tubes in the kidney, you'll need to watch for any bleeding.

If you develop a fever or chills, contact your doctor. These could be signs and symptoms of infection. Your doctor will probably take urine and blood tests and X-rays and then send you to the emergency department

Risks of Percutaneous Nephrolithotomy

As with most surgeries, you can have complications after your nephrolithotomy. But problems are uncommon.

Bleeding. Rarely, you might lose enough blood to require a blood transfusion.

Infection. Signs include a fever, drainage from the incision on your back, pain when you pee, or having to go to the bathroom a lot.

Tissue or organ injury. It’s uncommon, but the surgery could damage organs near the kidney, like your bowel, blood vessels, spleen, and liver.

10 common questions about kidney stone surgery through the back

1How long does it take to recover from kidney stone surgery?

4 to 6 weeks You may need to stay in the hospital for a few days. It can take 4 to 6 weeks to fully heal after open surgery.

2What happens after kidney stone surgery?

It is normal to have a small amount of blood in your urine for a few days to a few weeks after this procedure. You may have pain and nausea when the stone pieces pass. This can happen soon after treatment and may last for 4 to 8 weeks

3How long does it take to recover from percutaneous nephrolithotomy?

You can expect to return to work as soon as 1-2 weeks following surgery or as instructed by your physician. Nephrostomy Site Care: Caring for your nephrostomy tube is critical to ensure proper healing of your kidney

4What are the risks of kidney stone surgery?

The most common complications in this series included injury to the ureter, such as ureteral perforation and avulsion; retained or forgotten ureteral stent; and sepsis

5Is kidney stone surgery a major surgery?

Most patients leave the hospital stone free. Occasionally, though, another procedure will be needed to remove a stone. Even though it involves an incision, it is less invasive than a full open surgery to treat the kidney stone

6Is a 2 cm kidney stone big?

Introduction: The preferred treatment of >1cm stone is shockwave lithotripsy (SWL), while that of stone <2 cm is percutaneous nephrolithotomy (PCNL), but treatment of 1-2 cm renal stones is a controversial issue.

7How long does it take to recover from kidney stone removal?

Most stone fragments that are not removed pass out of the body within 24 hours. But sometimes it can take many weeks. If you have a large stone, you may need to come back for more treatments. This care sheet gives you a general idea about how long it will take for you to recover

8How long does stent stay in after kidney stone removal?

four to seven days A ureteral stent is typically removed four to seven days after surgery during a short office procedure, although sometimes the stent must stay in longer.

9Is stent removal painful?

The majority of patients reported moderate-to-severe levels of pain with stent removal, with an overall mean pain of 4.8 on a scale of 1 to 10. ... Kuehhas and colleagues reported that in their patients, pain during rigid cystoscopic stent removal was similar to that for office stent string removal.

10What is a PCNL procedure?

Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region

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kidney stone surgery through the back