Advances In Percutaneous Stone Surgery!

Advances In Percutaneous Stone Surgery!


By Dr. Chetan Sheladia, Urology

The Percutaneous Nephrolithotomy is an invasive treatment procedure that is administered while the patient is hospitalized. The procedure removes kidney stones with the help of a small incision that has been made into the skin. The percutaneous nephrolithotomy procedure is performed when other less invasive procedures are not feasible or have failed to meet the desired results.

What is ‘mini-perc’?

The ‘mini-perc’ technique falls under the category of percutaneous nephrolithotomy and is a more advanced type. It uses a 14-fr peel-away sheath in order to remove pyelocaliceal stones and determine appropriate introduction criteria.

Performance of Percutaneous Nephrolithotomy:

The PCNL technique involves a number of steps which are as follows:

• As part of the initial steps, the process involves the anaesthetist to administer the necessary dose of general anaesthesia.

• After the anaesthesia has taken due effect the urologist slips inside a cystoscope or a telescope like a tool with a torch and camera on each end. This is done in order to examine the urinary bladder.

• The urologist will then slip inside a tube or a catheter into the kidney and with the help of the tube injects a particular kind of dye that moves to the kidneys. This special kind of dye which is radio-opaque will help to highlight the stones when shown on the X-ray.

• Once the x-ray is able to locate the stone the urologist will make 1.5 cm incision on the back. Via these incisions, a needle which is being guided by the x-ray will access the kidney.

• A guide wire will enable the urologist to insert dilators of up to 1cm to further create passages to the kidney.

• After the passage has been created the urologist will insert tubes via which, further a nephroscope will be passed that will target the stones.

• Lastly, now the urologist will begin extracting the stones by using suction.

• If there is more than one stone in the kidney, the procedure might be repeated until the time all the stones have been removed.

Eligibility of Percutaneous Nephrolithotomy:

The patient is eligible to undergo the percutaneous nephrolithotomy if;

• The stones are bigger than 1.5 cms

• The doctor has given the verdict that the patient will not benefit from the lithotripsy method.

• The kidney is deformed.

What are the Risks Associated with this Procedure?

• Inability on the part of the doctor to create a tract with the dilator and needle

• Bleeding due to injury to the blood vessels

• There is a chance of development of an arteriovenous fistula

• Injury to nearby organs Aside from these few risks the benefits of a Percutaneous Nephrolithotomy far outweigh the cons. With this procedure you can avoid a number of other complications that are associated with open surgeries; you can eliminate a number of stones, can get back to daily activities sooner and experience less pain.