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:
- 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.
Accessing the kidney
Before undergoing percutaneous nephrolithotomy, your surgeon may have you go to the radiology department first. You will undergo local anesthesia, meaning you will be awake. The radiologist will use CT, ultrasound, or X-ray imaging to guide access to the kidney. You will then be transferred to the operating room for the actual procedure.
The surgeon may prefer to access the kidney in the operating room while you are under general anesthesia. In this case, the surgeon will put a tube through your bladder and up into your kidney, and will use X-ray imaging to make a puncture in your kidney so that the stones can be removed. If you have very large stones, the surgeon may need to make more than one puncture.
Removing the stones
When the doctor has access to the kidney stones, he or she will place a sheath into the kidney and break up the stones using a specialized instrument. When the fragments are small enough, the doctor will remove them. When the procedure is complete, the surgeon may leave drainage tubes in the kidney to ensure that all the fragments are gone.
Your doctor may send the kidney stone fragments to be analyzed or to check for infection.
After the procedure
You may stay in the hospital for one or two days after the procedure. Your doctor will recommend that you avoid heavy lifting, pushing or pulling for two to four weeks. You may be able to return to work after a week.
If the doctor has left drainage tubes in the kidney, you will need to watch for any bleeding. If you notice significant bleeding in your urine or from the tube (thick blood, like ketchup, or blood clots), go to the emergency department.
If you develop a fever or chills, contact your doctor. These could be signs and symptoms of infection. Your doctor will probably take urine and blood tests and X-rays and then send you to the emergency department. If you have significant pain that is not relieved by your prescribed pain medicine, contact your doctor.
Your doctor probably will want to see you again after four to six weeks. At that visit, your doctor may use ultrasound or X-rays to check for any stones that may be left and to make sure that urine is draining normally from the kidney.
Your doctor will also want to do some other tests to help determine what caused the kidney stones. You will also discuss ways to prevent getting more kidney stones in the future.