Definition and Overview
Percutaneous nephrolithotripsy is a safe procedure that removes kidneys stones by blasting them into smaller fragments before they are suctioned.
The kidneys are part of the urinary system found on each of the lower sides of the body. They are connected to the ureter and their main task is to remove toxic wastes and other by-products in the body.
In certain cases, the organs develop kidney stones, the most common of which are calcium stones, which form due to high levels of calcium oxalate in the urine. Other types include struvite stones, which are due to an infection that attacks the urinary track, and uric acid stones, which are the result of other conditions such as gout or a high protein diet. Regardless of the type, these stones can cause different health problems, such as the following:
- Chronic and excruciating pain, especially in the lower back. The pain can be so debilitating that it can significantly reduce a person’s quality of life.
- Obstruct the flow of urine if the stones are lodged in the tube connected to the ureter or bladder
- Kidney damage (in extreme cases)
The kind of treatment for kidney stones usually depends on their sizes. If they are less than one centimeter, they can be removed through ureteroscopy or shockwave lithotripsy. In ureteroscopy, a flexible tube with a camera is inserted into the ureter then into the kidney to locate the kidney stone. A laser fiber is then used to break up the stone, after which the fragments are allowed to pass through the body as urine or they are extracted. In shockwave lithotripsy, shockwaves are used outside the body to destroy the stones.
For large kidney stones, percutaneous nephrolithotripsy is often the first form of treatment.
Who Should Undergo and Expected Results
Percutaneous nephrolithotripsy is ideal for patients with kidney stones that are more than 2 centimeters. It is also considered if the patient has several kidney stones or they are too dense. Usually, these types of stones can no longer be removed by natural means—that is, through urine. They may also cause more obvious symptoms such as blood in the urine and flank pain.
The procedure is also performed if the kidney stones are already causing obstruction especially in the ureter and if other types of treatment fail to correct the condition.
How Does the Procedure Work?
Prior to the kidney stone removal, the patient goes through at least one consultation with the surgeon during which the surgeon can request a series of tests to determine if the patient is an ideal candidate for the procedure.
The patient will then be advised to fast a day before surgery and to stop taking certain medications at least a week before the procedure.
To surgery is performed under general anaesthesia and the patient’s heart rate and blood pressure are monitored by an anaesthesiologist all throughout the procedure. The patient lies down on the operating table with his back exposed. An incision of at least a centimeter is then made to insert a tube. A probe is then used to create a visual guide for the surgeon while a contrast dye is introduced to map the parts of the kidneys and reveal the exact location of the stones. The stones are either suctioned through a tube, in a procedure known as nephrolithomy, or broken down into fragments before they are removed.
The entire procedure may take 1 to 2 hours and typically requires up to 2 days of hospital stay.
Possible Risks and Complications
This type of kidney stone removal procedure has more pronounced risks and complications than other forms of treatment. For example, ureteroscopy and shockwave lithotripsy often do not require any hospitalisation, and patients can get back to their regular activities within 3 to 8 days. Recovery period for percutaneous lithotripsy takes between one to two weeks.
Other possible risks and complications may include:
- Damage to nearby organs including the bladder, colon and adrenal glands
- Injury to blood vessels of the kidneys, which can lead to kidney malfunction
- Internal bleeding
Infection at the wound site, which can cause a life-threatening systemic inflammation called sepsis
Over the years kidney stone removal has greatly improved, so these risks and complications are significantly minimised. Also, in the majority of cases, the benefits of percutaneous nephrolithotripsy outweigh the risks, as there is a very high chance that all stones will be removed.
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Fernstrom I, Johansson B. Percutaneous pyelolithotomy: A new extraction technique. Scand J UrolNephrol. 1976;10:257–9. [PubMed]