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Percutaneous nephrolithotomy

Percutaneous nephrolithotomy (nef-roe-lih-THOT-uh-me) is a procedure used to remove kidney stones from the body when they cannot pass on their own. This procedure uses small telescopes and instruments inserted through a small incision in your back to remove the kidney stones.

Percutaneous nephrolithotomy is used most often for larger stones or when other procedures, such as extracorporeal shock wave lithotripsy or ureteroscopy, are unsuccessful or not possible.

Why it's done Risks How you prepare What you can expect

The patient might need to revisit the doctor four to six weeks after the procedure, to see the medical condition of the patients and monitor the progress. During the revisit, the doctors might tell the patients to undergo an ultrasound or X-rays to make sure that there are no stones left in the kidney and the kidney work is working normally. 

The doctor may also advise undergoing some other tests to determine the cause of the kidney stone. This will help patients to prevent getting kidney stones again in the future. The patients must follow the instructions of the doctors to prevent further development of a kidney stone.

Percutaneous nephrolithotomy is recommended most often in the following situations:

  • Large kidney stones are blocking more than one branch of the collecting system of the kidney, also known as staghorn kidney stones
  • Kidney stones are larger than 0.4 to 0.6 inch (1 to 1.5 centimeter) in diameter
  • Large stones are in the ureter
  • Other therapies have failed
  • The person is obese

Before you undergo percutaneous nephrolithotomy, your doctor will perform several tests, including checking your urine for signs of infection or other problems, blood tests and computerized tomography (CT) to determine where the stones are in your kidney.

The most common risks from percutaneous nephrolithotomy include the following:

  • Bleeding
  • Infection
  • Injury to the kidney
  • Injuries to other organs
  • Incomplete stone removal

Percutaneous nephrolithotomy is performed in the hospital, and you will be given general anesthesia, meaning you will be asleep during the procedure.

Your doctor may prescribe antibiotics to reduce your chance of developing an infection after the procedure.

  • The patients is taken to the operation room, wherein general anesthesia is administered to the patient.
  • When the anesthesia starts working, the doctor inserts a protective sleeve called a sheath through the patient’s back into the kidney. A nephroscope is used with the sheath to locate and remove the stone.
  • Sometimes the doctors may use energy probe that helps to break the stones into small pieces. The energy probe may be electrohydraulic or ultrasonic.
  • After breaking the stone into small pieces, the doctor can remove them with the debris.
  • At the end of the process, the doctors may install a nephrostomy tube or a ureteral stent that helps to drain urine.
  • The place of the nephrostomy tube is covered with a dressing. Usually, the nephrostomy tube or the ureteral stent is connected to a drainage bag.
  • The kidney stones may be sent to the laboratory for infection and further testing if the doctors feel the requirement to do so.
  • The procedure is completed in 20 to 45 minutes. The goal of this surgery is to take out all the stones and the debris so that no stones are left out to pass on their own through the urinary tract.


After the procedure:

  • The patients are advised to stay in the hospital for one or two days after the procedure.
  • The patients may have to limit their activity after surgery. Patients require bed rest for at least 24 hours after the surgery. They can do the light activity after 2-3 days, but need to avoid sports or heavy lifting for 2-4 weeks. The patients can return to work only after one week and so.
  • Drainage tubes must be attached to the patient's kidney right after the surgery and the patients should have a look at the tubes to see if there is any thick blood present in the drainage tube. If the patient notices thick, ketchup-like blood or blood clots in the urine or drainage tube, the patients must go to the emergency department immediately.
  • The patients should monitor themselves for fever and chill. In case, the patients get fever due to infection, they must contact the doctors. The doctors may prescribe some antibiotics to reduce the infection. The patients should make sure that they complete the antibiotic course to avoid any further infection.
  • If the patients has any significant pain, which is not reduced after taking pain-killers, then the doctor should be contacted immediately. 



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