Percutaneous Nephrolithotomy (PCNL) in Delhi

Indications

PCNL is typically indicated for:

• Large kidney stones (usually larger than 2 cm).
• Stones causing obstruction and infection.
• Stones that have not been successfully treated with extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy.

Preoperative Preparation

• Evaluation: Patients undergo imaging studies such as CT scans, ultrasound, or intravenous pyelogram to assess the size, location, and number of stones.
• Lab Tests: Blood and urine tests are conducted to check for infection and kidney function.
• Antibiotics: Prophylactic antibiotics are often administered to prevent infection.

Procedure Steps

1. Anesthesia: The patient is placed under general or regional anesthesia.
2. Positioning: The patient is positioned prone (on their stomach) or supine (on their back), depending on the location of the stone and the surgeon’s preference.
3. Access:
   • Guide Wire Insertion: A guide wire is inserted through the skin into the kidney under fluoroscopic or ultrasound guidance.
   • Nephrostomy Tract: The tract is dilated using sequential dilators or a balloon dilator to create a pathway to the kidney.
4. Nephroscope Insertion: A nephroscope (a type of endoscope designed for kidney procedures) is inserted through the tract.
5. Stone Fragmentation: The kidney stones are located and fragmented using various energy sources such as ultrasonic, laser, or pneumatic lithotripsy.
6. Stone Removal: The stone fragments are removed using graspers or suction.
7. Final Inspection: The kidney is inspected for any remaining stone fragments.
8. Nephrostomy Tube Placement: A nephrostomy tube may be placed to drain urine from the kidney and ensure proper healing. Alternatively, a stent may be placed to allow urine to pass through the urinary tract naturally.

Postoperative Care

• Hospital Stay: Patients usually stay in the hospital for 1-2 days.
• Pain Management: Pain relief is provided as needed.
• Imaging: Follow-up imaging (such as X-rays or CT scans) ensures all stones are removed.
• Hydration: Patients are encouraged to drink plenty of fluids to help flush out any remaining stone fragments.
• Activity Restrictions: Patients may be advised to avoid strenuous activities for a few weeks.

Complications

While PCNL is generally safe, potential complications include:

• Infection.
• Bleeding.
• Injury to surrounding organs.
• Urine leakage.
• Residual stone fragments.

Follow-Up

Regular follow-up visits are essential to monitor kidney function, ensure proper healing, and prevent recurrence of stones. Patients may also receive dietary and lifestyle recommendations to reduce the risk of future stones.

Advantages of PCNL

• Minimally invasive with smaller incisions compared to open surgery.
• High success rate for removing large or complex stones.
• Shorter recovery time.

Conclusion

PCNL is a highly effective procedure for managing large kidney stones that cannot be treated with less invasive methods. With careful preoperative planning, skilled surgical technique, and appropriate postoperative care, patients can achieve excellent outcomes and relief from symptoms associated with kidney stones.