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Percutaneous nephrolithotomy or PCNL is a very effective procedure to remove stones of the kidneys. This procedure is particularly used when the stones are very large and are unable to pass on their own. In the PCNL method, the surgeon makes a small incision on the back of the patient to access the kidney and remove the stone or stones. This form of stone management is ideal for stones that are larger than 2cms in diameter or are very dense and hence, are not suitable for other methods.

What is PCNL?

PCNL is a great way to treat kidney stones via a minimally-invasive technique. In this method, a flexible tube is inserted into the kidney of the patient with the help of X-ray images. The tube is inserted by making an incision on the back of the patient. After the tube is put in the right place, a telescope is used made to pass through the tube to obtain a better view of the stone or stones.

For stones that are too large, a lithotripter is used to break them into smaller stones before they are removed through the PCNL procedure. Generally, a PCNL technique is considered very safe for stone removal and also has minimum post-operative complications. Moreover, this method has shorter recovery time and also does not require the patient to stay in the hospital for a long period. 

This method is particularly useful when large kidney stones tend to cause a lot of complications, such as restricting one or more collecting branch of the kidney. In cases, where the patient has a large stone in the ureter and other therapies have failed to provide results, a PCNL procedure can be used to provide relief.

What is PCNL MINI-PERC?

Another method which is less invasive than a PCNL procedure is a Miniaturized Percutaneous Nephrolithotomy (PCNL) (MINI-PERC). This method overcomes the disadvantages of a PCNL technique and hence, provides improved results. A MINI-PERC involves performing the PCNL procedure in one step by using a 16 G micro-puncture needle. In a further advanced version of this method, the surgeon uses an 8 Fr sheath to insert ultrasonic energy to treat urinary tract stones, especially kidney stones. This method is more advantageous as compared to a PCNL procedure. However, it is not very popular and widely used. Some of the major advantages of a MINI-PERC against a PCNL include low risk of haemorrhage, low postoperative pain, faster recovery, and shorter hospital stay. 

Why is PCNL done?

A PCNL procedure is performed on patients that have the following conditions:

  • Kidney stones those are difficult to remove because of their size being larger than 2cms in diameter.
  • Complications arising due to the presence of large kidney stones. These problems can range from mild to severe ones such as a blockage in one or more of the collecting branch of the kidney.
  • Existence of large stones in the ureter.

Moreover, a PCNL is best recommended for patients to who all other stone removal methods have failed to provide any relief. That said, before recommending a PCNL method, the doctor performs necessary blood and urine tests to assess the present health condition of the patient. Also, a CT scan can help understand the problem in-depth, including the size of the stone, the exact location, condition of the surrounding organs, etc.

What are the complications involved in PCNL?

Generally, PCNL surgery is very safe and does not have significant risks and complications. However, in some cases, the surgery might have the following risks:

  • Bleeding
  • Infection at the site of incision
  • Damage or injury to the nearby organs and tissues
  • Damage to the kidney
  • Incomplete removal of kidney stones

Additionally, in some cases, there is also a chance that the patient might require open surgery even after a PCNL procedure. This happens in circumstances when the surgeon cannot reach the stone in the kidney due to certain uncontrollable reasons.

What is the procedure of PCNL surgery?

Before beginning the procedure, the doctor administers the patient with anaesthesia. After this, a small incision is made on the back of the patient to access the kidney stone. The doctor passes a small, flexible tube through this incision into the kidney with the help of X-ray images. Once the tube is placed in the kidney, the surgeon passes a telescope through it to get a clear view of the stone and determine its exact size. It is also helpful in breaking the stone and then removing it from the body.

For patients that have very large stones, the PCNL surgery will involve using a lithotripter first to break the stones into smaller pieces. After which, they are successfully removed. Typically, a PCNL surgery takes about three to four hours, has minimum post-operative risks, faster recovery, and a shorter stay in hospital as compared to an open stone removal surgery. Moreover, a PCNL surgery has been more successful till now as compared to an extracorporeal shock wave lithotripsy (ESWL).

Overall, PCNL is a very widely used technique to remove large kidney stones, especially for patients who have not benefitted from other treatments.

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