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PERCUTANEOUS NEPHROLITHOTOMY

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PNL is a surgery to remove large stones directly from the kidney. The advantage is that even very large stones are removed in a single operation. Percutaneous Nephrolithotomy is carried out under general anaesthesia.
Compared to SWL and URS, PNL is more invasive and there is a higher risk of complications. The most common complications are bleeding and fever.

When should I consider PNL ?

Percutaneous Nephrolithotomy should be considered when your stone is very large (bigger 2 centimetres) and has not moved to the ureter. Your doctor may also discuss Percutaneous Nephrolithotomy as a treatment option if:

You have more than one stone

Your stone is very hard

How is PNL performed ?

PNL is carried out under general anaesthesia. While you are under anaesthesia, the doctor punctures the kidney with a needle through your skin. The doctor makes the puncture channel large enough to insert the nephroscope. Depending on the size of the stone, it is either removed completely or it is broken into smaller pieces first. Fragmentation of the stone is done with laser, ultrasound, or a pneumatic lithotripter (which works like a little jackhammer). At this point all stone fragments are removed. Sometimes a JJ-stent or a percutaneous nephrostomy tube is placed to make sure that urine can leave your kidney.

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When is PNL not recommended ?

PNL is a safe and effective procedure but there are some contraindications because the stone is accessed directly through the skin. If you take medication to prevent blood clotting you should stop taking it before the procedure. However, it is always important to discuss your individual situation with the doctor. In addition, PNL is not recommended if you are pregnant or if your physique makes it difficult to access the kidney.

How do I prepare for the procedure ?

Your doctor will advise you in detail about how to prepare for the operation. You must not eat, drink, or smoke for 6-8 hours before the procedure to prepare for general anaesthesia.

How long will it take me to get back to my normal daily activities ?

After PNL you will stay in the hospital for some days. In the case that you have a percutaneous nephrostomy tube, you will be discharged when the doctor or nurse can remove it. Your urine might be a little bloody for the first couple of days. Do not plan physical exercise the first two weeks after the procedure.

You need to go back to the hospital right away if you :

Develop a fever.

Feel pain in your kidney or flank.

Still have blood in your urine a week after the surgery.

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Advantages of PNL.

Even very big stones can be removed completely during one single operation.

Disadvantages of PNL.

Requires general anaesthesia.

Will leave a scar.

Longer hospital stay.

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