Percutaneous Nephrolithotomy (PCNL)

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1 Percutaneus Nephrlithtmy (PCNL) What is a percutaneus nephrlithtmy? is the mst effective f the cmmnly perfrmed prcedures fr kidney stnes. It is the best prcedure fr large and cmplex stnes. T perfrm this surgery, the urlgist makes a ½ inch incisin in yur back, and places a hllw tube that prvides access t the inside part f yur kidney that cntains the stnes. The urlgist inserts a stiff metal telescpe thrugh the tube and remves the stnes directly r by breaking them int fragments which are remved. What are the risks? Because f the incisin in the skin and the tube placed int the kidney, PCNL carries mre risk than the ther cmmnly perfrmed prcedures fr kidney stnes. This surgery requires at least an vernight stay in the hspital. It cannt be perfrmed in patients taking anticagulatin medicatins r thse with uncrrected bleeding disrders. What steps shuld I take t prepare fr the prcedure? 1. D nt eat any slid fd (including gum, hard candy r mints) after 12am (midnight) the night befre surgery. 2. D nt drink any milk prducts after 12am (midnight). Yu may drink water nly and any rutine medicatins up t 4 hurs befre yur surgery. 3. Wear lse, simple clthing which can easily be changed. Leave all jewelry and valuables at hme. 4. Bring alng t the hspital a respnsible adult cmpanin wh will: remain in the hspital, be available t hspital persnnel during yur - 1 -

2 prcedure, and assist yu upn discharge by driving yu hme with clse bservatin f yur cnditin. What shuld I expect befre the prcedure? 1. Yu will have lab tests and X-rays t ensure yur safety during the prcedure. 2. Arrive at the Infrmatin Desk, first flr, Main Hspital at the time requested. Please allw time t register and change yur clthing. Hspital persnnel will assist yu and escrt yu t the designated area. 3. Yu will receive an antibitic, either by muth r thrugh an IV, right befre the prcedure. 4. The anesthesia team attaches mnitring devices t yu. In almst all cases, they place yu under general anesthesia (medicatin that blcks pain and puts yu t sleep) fr this prcedure. 5. Yu will be taken t the Radilgy Suite, where the entire prcedure will be perfrmed. What will happen during the prcedure? 1. After yu are asleep, the surgical team places yu very carefully n yur stmach. 2. The urlgist and radilgist wrk tgether t place the hllw tube in the part f the kidney that prvides the best access t yur stnes. 3. Yur urlgist then remves the stnes, either directly r after breaking them int smaller fragments. 4. The prcedure can take as little as an hur r as lng as several hurs. 5. A temprary plastic tube is left inside yu at the end f the prcedure. One type f tube, called a nephrstmy tube, exits ut f the small incisin that was made in yur back. Anther type f tube, called a stent, is cmpletely internal. Yur urlgist will decide which tube t use based n many factrs

3 A Fley catheter is als placed in yur urethra. A Fley catheter is a tube that is passed thrugh the urethra and int the bladder t drain urine. 6. After the prcedure, yu will be mved t the pst-perative recvery area, usually fr abut 2 hurs. What shuld I expect after the prcedure? After waking up adequately, yu are taken t the Surgical Shrt Stay Unit where yu will transfer t a mre cmfrtable bed. Family members in the waiting rm are ntified f yur transfer and are allwed in t see yu nce we have yu settled. Yu can usually expect t stay in the Surgical Shrt Stay Unit fr 1-2 nights after yur prcedure. Will I have my wn rm? The Surgical Shrt Stay Unit des nt have individual patient rms. It is set up similar t the pre- and pst-p rms, with beds separated by curtains, which allws the nursing staff t clsely bserve yu and t respnd quickly t yur needs. Please nte that cell phne receptin in the Surgical Shrt Stay Unit is pr. When will my tubes be remved? Yur urine will drain ut f the tube in yur urethra and the tube cming ut f the incisin in yur back. Yu will ntice sme bld mixed with the urine in ne r bth tubes. The mrning after surgery, if the bld in the urine has decreased enugh, the tubes might be remved. Nephrstmy (back) tube: The tube cming ut f the incisin in yur back (if present) is remved in the Radilgy Suite after taking an X-ray

4 Internal Tube (stent): If an internal tube ( stent ) has been inserted the stent will be remved 1 r 2 weeks after yu are discharged frm the hspital with a minr prcedure in yur Urlgist s clinic. Smetimes the urlgist attaches a thread t the end f the stent in yur bladder and tape it t yur skin near the pening f the urethra. This will allw yu t remve yur wn stent at hme 3-5 days after the prcedure. Urethra Tube: The tube in the urethra is remved fllwing nephrstmy (back) tube remval, by deflating the balln hlding it in place, allwing it t gently slide ut. If the tubes are nt remved n the day after surgery, because there was t much bld in the urine r fr sme ther reasn related t yur prcedure, they are usually remved the fllwing week. After tubes are remved, and after yu have been able t urinate, yu are discharged frm the hspital. In sme cases, yu will be discharged with ne r mre tubes still in place. We will teach yu and yur family hw t care fr thse tubes, and hme nursing assistance will be prvided if needed. Hw will I manage my pain at hme? Yu will receive ral piid (narctic) tablets fr pain relief at hme. Opiids are medicatins that are used fr mderate t severe pain. Yu may r may nt receive antibitic pills, depending n a number f factrs. What are my activity instructins? Yu shuld avid strenuus activity r heavy lifting fr the week fllwing the prcedure r until the tubes cme ut. After that week, mst peple can resume nrmal activities withut pain

5 D nt drive any mtr vehicle r perated mtrized equipement fr at least 24 hurs after yur prcedure. D nt make any cmplex decisins, sign legal dcuments, r participate in activities ptentially harmful t thers, e.g., cking, nursing infants, withut supervisin fr at least 24 hurs after yur prcedure. This is t allw time fr the anesthetic t leave yur bdy. D nt drink alchl fr at least 24 hurs after yur prcedure. Begin eating fd slwly. Start with sips f liquids, fllwed by the additin f slid fds as tlerated. If yu d nt feel like eating slids, take liquids Nausea and/r vmiting cmmnly ccurs during this perid and is nt cnsidered abnrmal unless severe r persistent beynd the first day. When is my fllw up visit? Yu will have a fllw up visit with yur urlgist apprximately 6 weeks after surgery. At that time, we will take an X-ray t determine the prcedure s success and t assess fr any cmplicatins. Depending n yur risk f recurrence, yur dctr may rder further testing t help prevent future stnes. Disclaimer: This dcument cntains infrmatin and/r instructinal materials develped by Michigan Medicine fr the typical patient with yur cnditin. It may include links t nline cntent that was nt created by Michigan Medicine and fr which Michigan Medicine des nt assume respnsibility. It des nt replace medical advice frm yur health care prvider because yur experience may differ frm that f the typical patient. Talk t yur health care prvider if yu have any questins abut this dcument, yur cnditin r yur treatment plan. Authr: William Rberts MD, Jhn Hllingswrth MD, Sapan Ambani MD, Casey Dauw MD, Khurshid Ghani MD, Anna Silvenis RN, Breanna Frederick RN Patient Educatin by Michigan Medicine is licensed under a Creative Cmmns Attributin- NnCmmercial-ShareAlike 3.0 Unprted License. Last Revised 03/

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