PCNL Surgery

PCNL, which stands for percutaneous nephrolithotomy, is a surgical procedure used to remove staghorn calculi or complex kidney stones. Staghorn calculi are large stones that branch into multiple calyces of the renal collecting system, and if left untreated, they can cause serious health issues such as recurrent urinary tract infections, renal deterioration, and death.

CT scan without intravenous contrast is the preferred imaging modality for preoperative planning, as it allows for accurate assessment of stone morphology and location. The characteristics of the stone on CT imaging, such as the attenuation or Hounsfield measurement, can aid in determining stone fragility and composition.

PCNL is the gold standard first-line treatment for most staghorn calculi, as it offers high stone-free rates and low complication rates. Optimal access to the kidney is necessary for successful stone clearance, and gaining access through the upper or lower pole calyces is recommended. Access should be obtained below the level of the 11th rib, and multiple percutaneous access tracts may be utilized when treating large or complex stones.

Nephrostomy tube drainage after a PCNL procedure is often recommended, as it provides hemostatic tamponade of the tract, reliable drainage of the collecting system, and maintains access for future percutaneous procedures. Small-bore (9-12Fr) nephrostomy drainage is typically used, but large bore nephrostomy drainage (>20Fr) may be reserved for patients who have significant bleeding or a high risk of infection. Tubeless PCNL is an option in uncomplicated cases, which is associated with less postoperative pain and a shorter hospital stay.

It is important to note that PCNL is not without risks, and complications such as bleeding, infection, and injury to surrounding structures can occur. Patients may experience pain, blood in the urine, and other side effects after the procedure, and precautions such as adequate hydration and limited physical activity are necessary during recovery.

In terms of cost, PCNL surgery can vary depending on the hospital and surgeon, but it is generally considered an expensive procedure. However, the benefits of successful stone removal and prevention of further health issues outweigh the cost for many patients.