Removing Large Kidney Stones With A Small Incision
  Percutaneous Nephrolithotomy (PCNL)

Kidney stones (renal calculi) are one of the most common, and most painful, urologic conditions. Alliance Urology Specialists diagnoses and treats about 2,500 cases of kidney stones per year, and has the ability to visualize the entire urinary tract with in-office ultrasound, X-ray and CT scans. Minimally invasive, non-surgical treatments are available, but in some cases, the size and placement of the stone requires surgical intervention.

An advanced treatment for kidney stones offered by our urologists is percutaneous nephrolithotomy (PCNL). This procedure is an alternative to traditional open surgery and is utilized when lithotripsy has proven ineffective.

“Percutaneous nephrolithotomy is 95% effective in removing medium or larger stones from a patient’s kidney, and 88% effective in removing them from the ureter,” said practice urologist Mark Ottelin, MD, FACS.

The Procedure
A standard PCNL is performed under general anesthesia and usually takes about two hours to complete. After the patient has been anesthetized, a small incision, about 0.5 inches (1.3 cm) in length, is made in the patient’s back over the affected kidney. The surgeon then creates a track from the skin surface into the kidney and enlarges the track using an elongated dilating balloon. A sheath is passed over the inflated balloon to hold the track open. This process is performed utilizing a small guide wire.

After the track has been enlarged, a nephroscope is inserted. This instrument has a fiber-optic light source and additional channels for viewing the inside of the kidney and irrigating the area. The surgeon may use a device with a basket on the end to grasp and remove smaller kidney stones directly. Larger stones are broken up with an ultrasonic or electrohydraulic probe, or a holmium laser lithotriptor.

At the end of the procedure, a nephrostomy tube is placed in the incision site to allow for kidney drainage. The nephrostomy tube is usually removed within 24 hours but may be left in for a short time after the patient goes home. In select cases, the urologists of Alliance Urology Specialists can perform this procedure without the placement of a nephrostomy tube.

The PCNL procedure is often recommended for the treatment of kidney stones in the following instances:
  • Kidney stones are larger than 2 cm in diameter
  • Large, branching kidney stones
  • (Staghorn Calculi) caused by an infection
  • Blockage of urine flow is caused by the stones
  • Lithotripsy (ESWL) shock waves proved ineffective

Potential Risks of PCNL
  • Bleeding
  • Perforation of the kidney (usually heals without further treatment)
  • Injury to other abdominal organs
  • Damage due to surgery which affects normal
  • kidney function

For more information about treatment of kidney stones, call 336-274-1114.

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