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P.C.N.L

PCNL (Percutaneous Nephrolithotomy)

PCNL is an endoscopic procedure done through percutaneous route. It is used most often when kidney stones are too difficult to reach, too large, too numerous, or too dense to be treated by shock wave lithotripsy or ureteroscopy.

The procedure

 

  • PCNL is typically performed under general anaesthesia or spinal anaesthesia.
  • During this procedure, one small tube ureteric catheter is placed in tu ureter of procedure site and second small tube called a Foley’s catheter is placed in the bladder. The bladder catheter drains urine from the bladder and remains in place with the use of a balloon.
  • A contrast, or dye, may be infused through this ureteric catheter to provide a better view and show the exact stone location. This facilitates access to the kidney while your urinary tract is visualized using x-rays or ultrasound.
  • Once the stone is located, the kidney’s collecting system is accessed using a thin needle and a so-called guidewire is placed. The guidewire permits safe access for the nephroscope, a thin tube-like instrument used for viewing the inside of the kidney.
  • The access route is carefully opened until access with the nephroscope is possible.
  • Some stones can directly be removed using a grasper. This is called nephrolithotomy. Larger stones need to be broken up using a device like a laser before they can be removed. This is called nephrolithotripsy.
  • After all stones are removed, your surgeon will use contrast material to confirm that no stones or fragments were left behind in the kidney. When the contrast material moves easily through the bladder, this means that there are also no stones in the ureter. The ureter is the part which connects the kidney to the bladder.
  • In some patients, a temporary small tube called a ‘double-J stent’ may be placed to ensure that swelling does not block the drainage of urine. The JJ-stent remains in place by J-shaped curls in both the kidney and the bladder.
  • At the end of the procedure, a drainage catheter, called a ‘nephrostomy’, may be placed.

USES:-

Diagnostic uses:-

  1. Residual stone diagnosis
  2. Mallignant or benign mass
  3. Pelvi-caliceal stricture

Therapeutics:-

  1. Stone removal (>1 cm size)
  2. Biopsy of mass
  3. Drainage of hydronephrosis or pyonephrosis
  4. Stricture dilatation

Advantage:-

  1. Minimally invasive
  2. Larger stone removal
  3. Less blood loss
  4. Faster recovery
  5. Short post op stay and less pain

Disadvantage

  1. Infection
  2. Bleeding

Miniperc

It is miniaturisation of PCNL. Small renal stone is managed with miniperc. In which percutenious tract size is smaller than PCNL. It is an advanced technique.

 

Advantage:-

  • less pain and blood loss as compair to PCNL
  • suitable for non dilated pelvi-caliceal system

Disadvantage:-

  • Costly