Percutaneous Nephrolithotomy (PCNL)

Percutaneous nephrolithotomy (PCNL) is a procedure to remove medium-sized to large-sized kidney stones (stone with a diameter of more than two centimeters) using a scope that is inserted through a small incision in the back.

The procedure is used to treat kidney stone disease
  1. Percutaneous nephrolithotomy is done using general anesthesia so patients must undergo a thorough health screening before the procedure. This may include blood tests as well as tests to assess the functions of the heart and lungs to ensure you are healthy enough for both the general anesthesia and the procedure.
  2. You must avoid food and water for at least eight hours before the procedure.
  3. You will have to stop certain medications before the procedure, especially any that affect coagulation, such as aspirin. Please let the doctor know about all medications, supplements, and herbs that you are taking.
  4. Please let the doctor know about any allergies you have to medication, latex, and anesthesia, as well as any history you have of abnormal bleeding.
  5. If you suspect that you might be pregnant, please let your doctor know immediately.
Because percutaneous nephrolithotomy is done using general anesthesia, the patient will need to be assessed for any risks associated with the procedure. Once you pass the assessment you will receive anesthesia that will put you to sleep. The doctor will use a fluoroscope to determine the site for the insertion of the scope and make a small incision, about one centimeter in length, in your back. This allows the doctor to insert the nephroscope into the kidney. When the doctor finds the stone, they will break it up into smaller pieces using a small tool called a lithoclast lithotripsy before removing them through the incision. The doctor may also turn the stones into sand-like particles and remove it using ultrasonic lithotripsy.
  1. After the procedure you will be monitored closely by nurses until you are fully awake from the anesthesia. You will stay in the hospital for about three to five days.
  2. On the first day you may feel some pain at the incision site. You can take the prescribed pain medication.
  3. After the procedure you will have a catheter in the incision to drain urine. It will be removed after two to three days.
  4. Monitor the color of your urine. It may be red or dark in color. This will improve within a day or two.
  5. Drink at least three to four liters of water each day to help flush out any remaining pieces of the kidney stones.
  6. You can return to normal activities after one week.
  7. You can exercise after one month.
  • Infection: Before the procedure all patients will receive antibiotics to prevent infection. If you show signs of infection, such as high fever, pus at the incision, frequent urination or difficulty urinating, and/or severe pain, please let the doctor know immediately.
  • Bleeding: Excessive blood loss is possible during the procedure, but this is rare. In some cases the patient will require a blood transfusion.
  • Problems with the function of the kidneys after the procedure, adhesions that occur in the kidneys or ureters.
  • Open surgery is needed instead, which is rare, due to the kidney stone being too big or being in a location where it cannot be removed.
  • If you are traveling for treatment, plan to stay in Bangkok for at least three to five days after the procedure or throughout the duration of the treatment.
  • If you plan to travel after the procedure, please talk to your doctor before making any reservations. Patients can normally fly without any restrictions.
  • You will be examined on the day of your follow-up appointment and receive a “fit to fly” certificate if you need it.
Percutaneous nephrolithotomy can remove large kidney stones in one procedure through a small incision in the skin.
Small Stones
For stones smaller than five millimeters, treatment is often unnecessary and the patient will usually pass the stones on their own by:
  • Drinking up to two to three liters of water (if there are no restrictions) will help flush out the urinary tract.
  • Taking pain medication as needed because passing small stones can be uncomfortable.
  • Taking medication to relax the ureters so the stones can pass through more quickly and comfortably.
Medium-Sized Stones (Less Than Two Centimeters)
  • Using extracorporeal shock wave lithotripsy (ESWL) to break up the stones into sand-like particles so they can be more easily removed through urine.
  • Retrograde intrarenal surgery (RIRS) involves the insertion of a small camera through the urethra into the bladder and up to the ureters and kidneys to break up the stones with a laser. A double-J stent might be placed to help the stones move more easily into the bladder.

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