Percutaneous Nephrolithotomy (PCNL) » Department of Urology » College of Medicine » University of Florida (2023)

For kidney and ureteral stones that are too large (usually larger than 2 centimeters), too numerous, or too dense to be treated by extracorporeal shock wave lithotripsy (ESWL) or ureteroscopy, PCNL (percutaneous nephrolithotomy or stone extraction) offers a minimally invasive method of removing these stones.

Historically, large kidney and ureteral stones were removed through open surgery, requiring a large flank incision. Percutaneous nephrolithotomy is performed through a 1-cm skin incision and thus minimizes incision size, pain, blood loss, blood transfusions and shortens hospitalization. This technique also has a higher success rate for clearing all stones in one setting than other techniques such as ESWL, which often require several procedures.

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Our Surgeons

Percutaneous Nephrolithotomy (PCNL) » Department of Urology » College of Medicine » University of Florida (1)

Vincent G. Bird, MD
Professor
David A. Cofrin Endowed Chair in Endourology
Chief, Division of Minimally Invasive Surgery

Department of Urology
Click here for Video Biography

Percutaneous Nephrolithotomy (PCNL) » Department of Urology » College of Medicine » University of Florida (2)
(Video) Amazing Technical ModificationsTo Achieve Complecation Free PCNL by PROF. SVEN LEHME.

Benjamin K. Canales, MD, MPH
Associate Professor
Department of Urology
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John Michael DiBianco, MD
Assistant Professor
Department of Urology
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Russell S. Terry, MD
Assistant Professor
Director of MIS Education and New Technologies
Department of Urology
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(Video) Supine PCNL || Urology || PCNL ||

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Prior to Surgery

What to expect during you preoperative consultation:

  • Prior to your initial consultation, it is important for patients to obtain all Xray films (e.g. KUB, CT scan, MRI, sonogram) and reportsto bring to your surgeon for review. Your surgeon will review your medical history and perform a brief physical examination. A urinalysis will also be performed at your initial visit. All options for treatment of your stone(s) will be discussed at this time as well as the risks and benefits of each treatment. If your surgeon determines that you are a candidate for PCNL, you will then meet with a Surgery Scheduling Coordinator to arrange for the date of your operation.

What to expect prior to the surgery:

  • Once your surgery date is secured by one of our Surgery Scheduling Coordinators, the items listed below will be ordered as necessary based upon your age, medical history and risk for surgery. These will be performed through a preoperative anesthesia consultation at the Presurgical Center at UF & Shands that will be arranged for you at your initial visit. During this consultation you will have the opportunity to speak to the anesthesia staff regarding the types of anesthesia available and the risks/benefits.
    • Physical exam
    • EKG (electrocardiogram)
    • CBC (complete blood count)
    • PT / PTT (blood coagulation profile)
    • Comprehensive Metabolic Panel (blood chemistry profile)
    • Urinalysis and Urine Culture

Preparation for surgery

Medications to Avoid Prior to Surgery:

  • The following is a list of medications to avoid at least 7-10 days prior to surgery. Many of these medications can alter platelet function or your body’s ability to clot and therefore may contribute to unwanted bleeding during surgery. Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.
    • Aspirin, Motrin, Ibuprofen, Advil, Alka Seltzer, Vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix
    • A formal list of these medications and others will be provided to you by our Surgery

Signs and Treatment of Urinary Infections Prior to Surgery:

  • It is very important that your urine remain free of infection prior to PCNL. Therefore if you suspect that you may have a urinary tract infection (burning on urination, blood in the urine, urinary frequency and urgency, fevers), please notify your surgeon immediate so that proper cultures and treatment may be provided.

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The Surgery

PCNL is performed under general anesthesia with the patient lying face down on their abdomen. Once anesthesia is administered, your surgeon will perform cystoscopy (telescopic examination of your bladder) and instill xray dye or carbon dioxide into your kidney through a small catheter placed up through the ureter or drainage tube of the affected kidney to “map” the branches of the collecting system. This allows your surgeon to precisely locate the stone within the kidney and place a small needle through the skin under xray guidance to directly access the stone.

This needle tract is dilated to approximately 1-cm to allow placement of a plastic sheath and telescope to directly visualize the stone. Using an ultrasonic, mechanical or laser lithotripsy device, the stone is fragmented into small pieces and extracted out of the body through the sheath. On occasions, more than one tract may be required to access and attempts removal of all stones.

A small ureteral stent may be left draining the kidney to the bladder in addition to a nephrostomy tube draining the kidney to an external drainage bag at the end of the operation. The length of the surgery is generally 3-4 hours.

(Video) Urowebinar: Percutaneous nephrolithotripsy (PCNL)

Percutaneous Nephrolithotomy (PCNL) » Department of Urology » College of Medicine » University of Florida (5)

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Potential Risks and Complications

As with any surgical procedure there are risks and potential complications that are associated with PCNL. Although rare, potential risks include:

  • Bleeding:Blood loss during PCNL is generally minimal, and risk of blood transfusion ranges from 2-12%, depending on stone size, location, and number of tracts dilated. Although not required, patients may elect to donate blood about 2 months in advance of surgery at their local Red Cross center.
  • Infection:Bacteria can at times grow within stones and therefore cause a urinary infection and rarely sepsis during stone surgery. As a result, urinary infections should be treated before surgery and broad-spectrum antibiotics are administered at the start of the operation to minimize the risk of a urinary infection.
  • Adjacent Tissue and Organ Injury:Rarely organs surrounding the kidney such as bowel, colon, blood vessels, spleen, and liver may be injured during surgery requiring emergent open surgery or further surgery. The chest cavity is in close proximity to the upper pole of the kidney and can be accidentally entered when accessing an upper pole kidney stone resulting in a pneumothorax (or air surrounding the lung). This may require that a small chest tube be placed temporarily to drain air and fluid from around the lung. Permanent damage to the kidney during PCNL resulting in loss of the kidney is extremely rare. Damage and perforation to the ureter draining the kidney may result in scarring and obstruction requiring further surgery.
  • Failure to Remove the Stone:Despite placement of one or more tracts into the kidney to remove stones, there is a small chance that PCNL may not be able to successfully removeallstones as a result of either size, number or location of the stone within the collecting system.Additional treatment may be required.

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What to Expect After Surgery

Following your surgery you will be transferred to the recovery room and then to your hospital room once you are fully awake.

  • Post-operative pain:Following surgery, pain in the flank area overlying your kidney is common for the first few days, but well controlled with intravenous or oral pain medication provided to you on request by your nurse.
  • Nephrostomy Tube:A nephrostomy tube drains urine directly from your kidney into a drainage bag. It is routinely placed to tamponade bleeding from the tract between the skin and the kidney. Urine from the kidney is often blood-tinged and will clear over the ensuing days following surgery. There is a possibility that you will be discharged from the hospital with the nephrostomy tube as deemed necessary by your surgeon. The nephrostomy tube will then be removed in the office at the bedside generally 1-2 weeks following surgery.
  • Ureteral Stent:A ureteral stent is a small flexible plastic internal tube that is placed to promote drainage of your kidney down to the bladder. This will be removed in your surgeon’s office in typically 1-2 weeks following surgery.
  • Nausea:Often patients experience transient nausea the first day or two following surgery under general anesthesia.Medication is available to treat persistent nausea.
  • Urinary Catheter:A bladder catheter called a foley is placed in the operating room while you are asleep and left in place for approximately one day after the surgery. This allows your surgical team to continuously monitor your urine output. It is not uncommon to have blood-tinged urine for a several days after surgery. The catheter will be removed prior to discharge.
  • Diet:Your diet will be advanced slowly from clear liquids to solid foods as tolerated over the first two days following surgery. In addition, intravenous fluids will be administered to keep your body well hydrated following surgery. Most patients, however, will not regain their appetite until they are discharged and at home.
  • Fatigue:Fatigue is common and should start to subside in a few weeks to a month following surgery.
  • Incentive Spirometry:Deep breathing exercises are important in reducing the incidence of pulmonary complications such as pneumonia. These exercises will be performed with the use of an incentive spirometer, which your nurses and surgical team will explain how to use.
  • Physical Activity:On the evening of surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can also expect to have SCD’s (sequential compression devices) to prevent blood clots from forming in your legs. During your hospital stay it is advised that you walk at least 4-6 times in the hallways per day to minimize risks of clots. The more walking you can tolerate the better.
  • Hospital Stay:The length of hospital stay for most patients is approximately 1-2 day.
  • Secondary Procedures:On occasions, a second PCNL procedure may be required as a “second look” procedure through the original nephrostomy tract to retrieve any retained stone fragments. This procedure may be performed during your hospitalization or at a second surgery date as determined by your surgeon.

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(Video) AUA Masterclass Webinar: Mini PCNL (2020)

What to Expect After Discharge from the Hospital

  • Pain Control:Mild pain at the nephrostomy tube site may require pain medication, however, patients are encouraged to transition to extra strength Tylenol as soon as possible to avoid constipation and over sedation which may occur as a result of narcotic pain medications.
  • Showering:Showering with your nephrostomy tube in place is permissible; however, the site should be patted dry immediately after showering. Tub baths or hot tubs should be avoided while your nephrostomy tube is in place.
  • Activity:Taking daily walks is advised to minimize blood clots, called a deep vein thrombosis, from forming in your legs. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible, however, should be taken slowly. Driving should be avoided for at least 1-2 weeks after surgery and only after narcotic pain medications have been stopped. After this time, activity can begin as tolerated. 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. It is important that urine flow freely from the tube and into the drainage bag, which should be kept below the level of your kidney at all times. Clean the area around the nephrostomy tube insertion site with mild soap and water each day when you shower. Pat the area dry after showering and clean directly around the insertion site with hydrogen peroxide using a cotton tip applicator. Apply a clean gauze dressing after cleaning the area.If urine stops draining from your tube, this may result in obstruction of your kidney, increased pain and infection. Immediately check your nephrostomy tube to ensure that it is not kinked or has not been pulled or dislodged from proper position. If you experience any change in pain, fever, chills, pus forming around the insertion site, the catheter not draining or leaking around the tube you must contact your doctor immediately.
  • Follow-up for Stent Removal:The ureteral stent is generally removed within 1-2 weeks following surgery and will be determined by your surgeon. While your stent is in place, it is common to feel a slight amount of flank fullness and urgency to void as a result of the stent. These symptoms often improve over time as the body adjusts to the indwelling stent.The stent is removed by cystoscopy during which time your surgeon will place a small flexible telescope into the urethra to visualize and grasp the terminal end of the stent that rests in your bladder. This generally takes less than a couple of minutes to perform.
  • NOTE: It is critical that patients return to have their ureteral stent removed as instructed by their surgeon as a prolonged indwelling ureteral stent can result in encrustation by stone debris, infection, and obstruction and potential loss of the kidney.
  • Follow-up Appointment:A follow-up appointment will be scheduled by your surgery team at the UF Health Medical Plaza Urology Clinic prior to discharge from the hospital or patients may also call 352.265.8240.

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When to call your Doctor

Although adverse events are rare following PCNL, it is important for patients to recognize these events and know when to contact their surgeon. You should contact your surgeon or primary care doctor immediately if any of the following occur:

  • Worsening pain over the ensuing days following PCNL. If this pain continues to escalate despite the use of oral pain medication, this may indicate obstruction of the kidney from a large stone fragment lodged within the ureter, hematoma around the kidney or infection of the kidney.
  • Large amounts of blood clots in the urine that may lead to difficulty with voiding and fully emptying the bladder.
  • Fevers >101oF may indicate a serious infection within the urinary tract.
  • Nausea and vomiting
  • Chest pain or difficulty breathing

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Frequently Asked Questions (FAQs)

What is the advantage of PCNL as compared to other stone treatments?

  • The primary advantage of PCNL over other treatments such as ESWL or ureteroscopy is that it provides a minimally invasive approach to treating and removing large stone burden in a single setting as compared to the need for multiple surgeries with the other therapies mentioned.

Are there disadvantages?

  • Whereas ESWL and ureteroscopy can be performed under intravenous sedation, PCNL requires a general anesthesia. Some patients may not be able to tolerate a general anesthesia due to their medical condition(s). As compared to other stone treatments, PCNL is slightly more invasive carrying with it a slightly higher risk. However, for most patients with large stone burdens, multiple stones or stones resistant to other forms of treatment, the benefits of PCNL outweigh the risks.

Which patients are good candidates for PCNL?

  • PCNL is an excellent option for patients with large kidney or ureteral stones (generally > 2 cm), multiple large stones, or stones resistant to prior treatment with ESWL or ureteroscopy.

What patients arenot good candidates for PCNL?

  • Patients who have severe heart or lung conditions or have an uncorrectable bleeding propensity are not good candidates for PCNL. Patients with an active urinary infection are at a higher risk of sepsis during surgery and therefore should be treated with antibiotics to clear up the urinary infection prior to PCNL.

Can multiple stones be treated simultaneously with PCNL?

  • Multiple stones can be treated with PCNL. This is one of the advantages of this approach as a flexible telescope can be passed through the skin and directly into the kidney to attempt identification and removal of multiple stones in one setting. However, at times it may be difficult to visualize all areas of the collecting system despite the use of flexible telescopes and therefore some stones may not be retrievable. This may require placement of a second needle tract to access the remaining stones or a second PCNL procedure at a later date. Alternatively, PCNL can be used to remove the majority of the stone burden with ureteroscopy and ESWL left to clean up the remaining stone fragments.

Will I need placement of an indwelling ureteral stent following PCNL?

  • In most cases an indwelling ureteral stent is placed to promote drainage of urine from the kidney to the bladder.

What is the overall success rate with PCNL?

  • The success of PCNL is dependent on many factors such as stone composition, stone size, number of stones, location within the urinary tract, patient body habitus (obesity), and anatomy of the collecting system of the kidney. Our surgeons carefully consider all of the aforementioned variables and will discuss this with you in order to maximize success and determine if PCNL is right for you. Overall stone free success rate is approximately 80-90% following an initial PCNL and 90-100% following a “second look” procedure.

How do I know if PCNL was successful?

  • Following PCNL, your surgeon will determine whether the treatment was successful based upon a CT scan that is performed during your hospitalization on the first postoperative day. If stone fragments remain within the urinary tract, more time may be required to allow for spontaneous passage, which often takes several weeks. Alternatively your surgeon may recommend further treatment with repeat PCNL, ESWL, or ureteroscopy.

Can PCNL be repeated?

  • Yes. Often due to stone density or size or difficult anatomy of the collecting system, fragments may at times remain in the urinary tract that may require a “second look” procedure to attempt removal. This is usually performed a few days after your initial surgery. Alternatively this second procedure may be staged at a later date depending upon your surgeon.

Can PCNL be performed on both of my kidneys at the same time?

  • If patients present with large stone burdens in both kidneys, bilateral PCNL surgeries can be performed at the same setting or alternatively staged at a later date as two separate surgeries. This decision will be made with you by your surgeon.

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FAQs

Is PCNL a major surgery or minor surgery? ›

In the era of minimally invasive surgery, RIRS and PCNL are two major surgical techniques for removing large renal stones [3], and PCNL has become the standard treatment with which all other approaches should be compared.

What size kidney stone requires PCNL? ›

Percutaneous nephrolithotomy is typically recommended when: Large kidney stones block more than one branch of the collecting system of the kidney. These are known as staghorn kidney stones. Kidney stones are larger than 0.8 inch (2 centimeters) in diameter.

How much time takes for PCNL surgery? ›

Typically, the length of the surgery is three to four hours. The surgery is performed by making a small 1 cm incision in the patient's flank area (Figure 1). A tube is placed through the incision into the kidney under x-ray guidance.

What is the success rate of percutaneous nephrolithotomy? ›

The success rate of stone clearance according to Guy's stone score was 97.8 %, 95.3%, 80% and 50% for Guy's score 1, 2, 3 and 4 respectively (Table 2).

How painful is PCNL surgery? ›

Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for removing renal calculi, while a large number of patients experience acute moderate-to-severe pain despite the analgesia provided.

Can PCNL damage kidneys? ›

As an operation requiring kidney puncturing, however, PCNL unavoidably can damage renal function to certain degree. A recent study demonstrates that PCNL is safe and effective for solitary kidney patients and can improve renal function at the post-operative sixth month (4).

What should I avoid after PCNL surgery? ›

Avoid heavy lifting (more than 15 lbs.) for 4 weeks after your procedure. Avoid fast stair climbing, long walks and driving for the first 3 weeks. Avoid sexual activity for 2 weeks after the surgery.

What size of kidney stone is too big to pass? ›

Kidney stones that are larger than 5 mm are often too large to pass through the ureter spontaneously. Oftentimes, treatment is needed. Bottom line, the larger the stone, the less likely it will pass on its own.

What size kidney stone is considered large? ›

Large kidney stones are stones that measure approximately 5 mm or larger. Based on their size, they may have trouble moving through the urinary tract out of the body. In fact, they are prone to become lodged causing severe pain and other symptoms.

How long does it take for kidney to heal after PCNL? ›

You should be able to resume normal activities in one to two weeks.

How long will I be off work after kidney stone surgery? ›

While the recovery times vary for each procedure, most patients are fully recovered within six weeks and can resume their normal activities. Many patients feel much better the first week, but care must be taken to assure that healing is complete.

Is percutaneous nephrolithotomy major surgery? ›

While minimally invasive, PCNL is still major surgery and it will take you several days to start feeling better.

How safe is percutaneous nephrolithotomy? ›

Conclusion: PCNL in solitary kidneys is safe with an acceptable complication rate if performed in a high volume center. Outcomes are good, although auxiliary procedures may be necessary. Renal function remains stable or improves after procedure.

How long can a nephrostomy tube remain in kidney? ›

A nephrostomy tube is placed on a temporary basis only. It may remain in place for a few days, weeks or months. If it needs to stay for a relatively long period of time, a new one may be placed at intervals. The nephrostomy tube should drain urine continuously when it is connected to a drainage bag.

Will removing kidney stones improve kidney function? ›

A stone obstructing the kidney causes renal dysfunction that typically improves or resolves upon removal.

How do you sleep with a nephrostomy? ›

Lying on the side of the tube may be uncomfortable so try the other side. If you have tubes in both kidneys, find a position that suits you. Tip: Try to place the urostomy bag in a good position to allow the connections to be in the curve of the waist to avoid discomfort and to make it easier for sleeping.

Does PCNL require stent? ›

Usually, a temporary device (ureteral stent or nephrostomy tube) for urinary drainage is needed after a PCNL. A stent in internal and goes from the kidney to the bladder while a nephrostomy tube directly drains urine from the kidney to an external bag.

How long can a person live with a nephrostomy tube? ›

Its duration can be from a few weeks to many years, or they may even carry the tubes permanently. Therefore, patients should learn to live with tubes for a certain time( 8 ).

What are the complications of PCNL? ›

The complications following PCNL are infection, hemorrhage, adjacent organ injury, retained stone, loss of kidney function, and death. The Clinical Research Office of the Endourological Society (CROES) conducted two multicenter global studies on the complications following PCNL.

Does creatinine increase after PCNL? ›

Creatinine levels showed a significant increase in 48 h after the operation. The mean preoperative creatinine level was (1.32 ± 0.18 mg/dL) and postoperative values were as follows: 6th h = 1.34 ± 0.17 mg/dL, 24th h = 1.44 ± 0.21 mg/dL, 48th h = 1.59 ± 0.24 mg/dL.

What are the risks and complications involved with PCNL? ›

Relevant studies on complication of PNL
Series (citation)Shin (22)El Nahas (19)
Sepsis0.60.4
Colonic injury0.7NA
Pleural injury1.12.4
Extravasation/urine leak0.48
6 more rows
7 Dec 2012

What can you eat after PCNL surgery? ›

You may return to your normal diet after surgery. Mild nausea and possibly vomiting may occur in the first 6-8 hours following surgery. This is usually due to the side effects of anesthesia and will resolve soon. We suggest clear liquids and a light meal the first evening following surgery.

Which fruit is good after kidney stone surgery? ›

Increase the amount of citrus fruit in your daily diet Citrus fruits and their juices can help reduce or prevent stone formation due to naturally produced citrate. Fruits that are beneficial for people with kidney stones include: Lemons, oranges, and grapefruit.

What drink good for kidney stones? ›

Enjoy some lemons.

Citrate, a salt in citric acid, binds to calcium and helps block stone formation. "Studies have shown that drinking ½ cup of lemon juice concentrate diluted in water each day, or the juice of two lemons, can increase urine citrate and likely reduce kidney stone risk," says Dr. Eisner.

Does coffee cause kidney stones? ›

Caffeine intake has been shown to be associated with increased urinary calcium excretion (6) and, as such, could potentially increase the risk of developing kidney stones, although in our previous reports we consistently found an inverse association between consumption of caffeine-containing beverages, such as coffee ...

What foods cause kidney stones? ›

Avoid stone-forming foods: Beets, chocolate, spinach, rhubarb, tea, and most nuts are rich in oxalate, which can contribute to kidney stones. If you suffer from stones, your doctor may advise you to avoid these foods or to consume them in smaller amounts.

Can you pass a 11mm kidney stone? ›

Most evidence suggests that stones less than 10 mm in diameter have a reasonable chance of passing through the urinary tract spontaneously. You may be offered medical expulsive therapy (MET) using an alpha blocker medication, such as tamsulosin.

Which type of kidney stone is the hardest? ›

Cystine stones are very hard stones. Many doctors call them the hardest kidney stones a human can make. This makes them more difficult to break and completely remove. Cystine stones grow in the urine when there is too much cystine in the urine (or cystinuria).

Can you pass a 9 mm kidney stone? ›

(See 'Preventing future kidney stones' below.) If the stone does not pass — Stones larger than 9 or 10 millimeters rarely pass on their own and generally require a procedure to break up or remove the stone. Some smaller stones also do not pass.

What size kidney stone requires surgery? ›

Surgical treatment is usually recommended for stones 0.5 centimeters in size and larger, as well as for patients who fail conservative management. The procedures used today to remove stones are minimally invasive and highly effective.

Which anesthesia is used for PCNL? ›

The General Anaesthesia (GA) is the standard modality for PCNL. However, few studies conclude that Spinal Anaesthesia (SA) can be an alternative method of anaesthesia with similar incidence of complications.

Can you pass a kidney stone with a stent in? ›

Conclusions: A small, but clinically significant percentage of ureteral stones pass spontaneously with a ureteral stent in place. Small stone size is associated with an increased likelihood of spontaneous passage in patients with indwelling stents.

Is PCNL an outpatient procedure? ›

PCNL can be safely performed with excellent outcomes as an outpatient procedure.

Are you put to sleep for a kidney stent? ›

The blockage may be caused by problems such as a kidney stone, a tumour, or an infection. The stent keeps the ureter open. After the stent is placed, urine should flow better from your kidneys to your bladder. You will get medicine to make you sleep and to prevent pain during the procedure.

Can I drink coffee after kidney stone surgery? ›

On the other hand, because the restriction of dietary oxalate is one of the recommended ways to reduce the risk of CaOx kidney stone occurrence or recurrence, coffee and tea, which have been recognized as oxalate-rich beverages, are widely recommended as beverages to avoid.

How long will I pee blood after kidney stone surgery? ›

What to Expect at Home. 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.

Who performs percutaneous nephrolithotomy? ›

The surgery consists of the urologist making a ½ inch incision in your back, through which is placed a hollow tube that provides access to the inside part of your kidney that contains the stone(s). Using a rigid metal telescope, the stones are removed directly or broken into fragments which are removed.

Can I drink alcohol after PCNL surgery? ›

Alcoholic beverages are best avoided in the first 24 hours and while taking any narcotic pain medications. It is important to drink plenty of water (6-8 glasses daily) after your kidney surgery to stay well hydrated and avoid constipation.

Is PCNL minimally invasive? ›

More recently, there has been a trend to use smaller and smaller nephrostomy tracts—the so-called minimally invasive PCNL (mini-PCNL or MPCNL) to reduce the morbidities associated with PCNL.

Why would a physician perform percutaneous nephrolithotomy on a patient? ›

Percutaneous nephrolithotomy is a procedure to remove problem kidney stones that are too large to pass on their own. Typically this procedure is used when other methods are unsuccessful or not possible.

Is nephrostomy tube placement a major surgery? ›

Operative nephrostomy is a major surgical procedure requiring general anesthesia for, what may be a transitory obstruction and already impaired renal function may make it hazardous.

How is a stent removed after kidney stone surgery? ›

Ureteral stents hold open the ureters, tubes that allow urine to flow from the kidneys into the bladder.
...
To remove the stent during a procedure, your provider:
  1. Inserts a cystoscope through the urethra and into the bladder.
  2. Uses tiny clamps attached to the cystoscope to grab onto the stent.
  3. Gently removes the stent.
25 Aug 2021

How do you shower with a nephrostomy bag? ›

Do not swim or take baths while you have a nephrostomy tube. You can shower after wrapping the end of the nephrostomy tube with plastic wrap. Change the dressing around the nephrostomy tube about every 3 days or when it gets wet or dirty. A nurse will teach you how to change the dressing.

Are you put to sleep for nephrostomy tube? ›

General anesthesia will keep you asleep and free from pain during the procedure. You may get anesthesia through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

Is it painful to have a nephrostomy tube removed? ›

Postoperative Symptoms

Pain Most patients experience mild to moderate pain at the surgery site, especially if a nephrostomy (kidney) drain is present. The pain improves significantly following removal of the nephrostomy tube. Nevertheless, it can take several weeks for the pain to resolve.

Can Pcnl damage kidneys? ›

As an operation requiring kidney puncturing, however, PCNL unavoidably can damage renal function to certain degree. A recent study demonstrates that PCNL is safe and effective for solitary kidney patients and can improve renal function at the post-operative sixth month (4).

Do kidney stones mean kidney failure? ›

Kidney stones are not the same thing as kidney failure.

But, as you can see, since there are some similar symptoms for both kidney stones and kidney failure so it is important that you contact your primary care provider immediately if you have any of these symptoms for a complete evaluation.

Do kidney stones count as kidney disease? ›

KIdney stones is a form of kidney disease but does not always cause CKD. If the glomerular filtration rate (GFR) falls to less than 60 milliliters per minute per 1.73 meters squared, or if blood or protein end up in the urine, and is present for more than 3 months, then it qualifies for CKD.

Is PCNL an outpatient procedure? ›

PCNL can be safely performed with excellent outcomes as an outpatient procedure.

What should I avoid after PCNL surgery? ›

Avoid heavy lifting (more than 15 lbs.) for 4 weeks after your procedure. Avoid fast stair climbing, long walks and driving for the first 3 weeks. Avoid sexual activity for 2 weeks after the surgery.

What are the complications of PCNL? ›

The complications following PCNL are infection, hemorrhage, adjacent organ injury, retained stone, loss of kidney function, and death. The Clinical Research Office of the Endourological Society (CROES) conducted two multicenter global studies on the complications following PCNL.

Can I drink alcohol after PCNL surgery? ›

Alcoholic beverages are best avoided in the first 24 hours and while taking any narcotic pain medications. It is important to drink plenty of water (6-8 glasses daily) after your kidney surgery to stay well hydrated and avoid constipation.

How long is blood in urine after PCNL? ›

Hematuria Hematuria (blood in the urine) will always be present following the procedure and usually lasts until a few days after the ureteral stent is removed. The amount of blood in the urine is typically heaviest over the first one to two days.

Who performs percutaneous nephrolithotomy? ›

The surgery consists of the urologist making a ½ inch incision in your back, through which is placed a hollow tube that provides access to the inside part of your kidney that contains the stone(s). Using a rigid metal telescope, the stones are removed directly or broken into fragments which are removed.

How long can a nephrostomy tube remain in kidney? ›

A nephrostomy tube is placed on a temporary basis only. It may remain in place for a few days, weeks or months. If it needs to stay for a relatively long period of time, a new one may be placed at intervals. The nephrostomy tube should drain urine continuously when it is connected to a drainage bag.

How do you sleep with a nephrostomy? ›

Lying on the side of the tube may be uncomfortable so try the other side. If you have tubes in both kidneys, find a position that suits you. Tip: Try to place the urostomy bag in a good position to allow the connections to be in the curve of the waist to avoid discomfort and to make it easier for sleeping.

What can you eat after PCNL surgery? ›

You may return to your normal diet after surgery. Mild nausea and possibly vomiting may occur in the first 6-8 hours following surgery. This is usually due to the side effects of anesthesia and will resolve soon. We suggest clear liquids and a light meal the first evening following surgery.

Which fruit is good after kidney stone surgery? ›

Increase the amount of citrus fruit in your daily diet Citrus fruits and their juices can help reduce or prevent stone formation due to naturally produced citrate. Fruits that are beneficial for people with kidney stones include: Lemons, oranges, and grapefruit.

Is PCNL surgery safe? ›

In complex renal stones, PCNL is a safe and efficient tool in the armamentarium of renal stone management with a relatively low incidence of significant complications. Compared to open surgery, PCNL has the advantages of having a high rate of stone clearance and being cost-effective.

Why would a physician perform percutaneous nephrolithotomy on a patient? ›

Percutaneous nephrolithotomy is a procedure to remove problem kidney stones that are too large to pass on their own. Typically this procedure is used when other methods are unsuccessful or not possible.

Can a nephrostomy tube cause sepsis? ›

Percutaneous catheter nephrostomy (PCN) is associated with sepsis in 1-3% of cases. Of pyonephrosis-associated PCN tube placements, 7-9% of cases are associated with septic shock.

Is stent necessary after PCNL? ›

Will I need placement of an indwelling ureteral stent following PCNL? In most cases an indwelling ureteral stent is placed to promote drainage of urine from the kidney to the bladder.

Do you still urinate with nephrostomy? ›

If you have only one tube, you still need to urinate. Your other kidney will still produce urine that will drain into your bladder. Having a nephrostomy tube in for a long time increases the risk of getting an infection.

How safe is percutaneous nephrolithotomy? ›

Conclusion: PCNL in solitary kidneys is safe with an acceptable complication rate if performed in a high volume center. Outcomes are good, although auxiliary procedures may be necessary. Renal function remains stable or improves after procedure.

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