PCNL Surgery cost in India

Know More About Procedure & Surgery

What is PCNL?

PCNL refers to Percutaneous Nephrolithonomy. PCNL is a technique used to remove certain stones in the kidney or upper ureter (the tube that drains urine from the kidney to the bladder) that are too large for other forms of stone treatment such as shock wave lithotripsy or ureteroscopy. Kidney stones are formed in the urinary tract due to crystallization of chemical compounds in the urine.

Benefits of PCNL

• Post-procedure stone free rate of greater than 97%.
• Less post-operative pain as compared to open surgery.
• Fewer complications as compared to open surgery due to the small incision and minimally invasive access to the kidney.
• Quicker return to activities of daily living and work compared to open surgery.
• Better stone free rates post-procedure for larger and more complex stones as compared to less invasive options (SWL and ureteroscopy).
• Tubeless PCNL offers patients the benefits of no urine leakage, no discomfort from an external drainage tube and many patients report a quicker recover.

Risks involved in PCNL

• Bleeding: Some blood loss will occur with this procedure but rarely do patients require a blood transfusion. If you are interested in autologous blood transfusion (donating your own blood) you must make your surgeon aware.
• Infection: All patients are treated with broad-spectrum antibiotics to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from incision, urinary frequency or discomfort, pain or anything that you may be concerned about) please contact your doctor.
• Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue/organs including bowel, vascular structures, spleen, liver, lung, pancreas and gallbladder could require further surgery. Loss of kidney function is rare but is a potential risk. Scar tissue may also form in the kidney or ureter requiring further surgery.
• Conversion to open surgery: This surgical procedure may require conversion to the standard open operation if difficulty is encountered during this procedure. This could result in a larger standard open incision and possibly a longer recuperation period.
• Failure to Remove the Stone: There is a possibility that the stone(s) may not be able to be removed completely, usually either due to the size or location of the stone(s). Additional treatment may be require

What do I need to bring to surgery?

• Physical exam
• EKG (electrocardiogram)
• CBC (complete blood count)
• PT / PTT (blood coagulation profile)
• Comprehensive Metabolic Panel (blood chemistry profile)
• Urinalysis and Urine Culture

Surgery

The operation is performed under a general anesthetic and lasts approximately 2 to 3 hours. It is a team effort requiring coordination between your surgeon, anesthetist, radiographer and theatre nursing staff.

The surgery is performed by making a small 1 cm incision in the patient’s flank area. A tube is placed through the incision into the kidney under x-ray guidance. A small telescope is then passed through the tube in order to visualize the stone, break it up and remove it from the body. If necessary a laser or other device called a lithotripter may be used to break up the stone before it can be removed. This procedure has resulted in significantly less post-operative pain, a shorter hospital stay, and earlier return to work and daily activities when compared to open stone surgery. This technique also has a higher success rate for clearing all stones in one setting than other techniques such as extracorporeal shock wave lithotripsy (ESWL), which often require several attempts.

Post Surgery

• Post-operative pain: Pain in the flank area overlying your kidney is common for the first few days, but well controlled with intravenous or oral pain medication provided to you on request by your nurse.
• Nephrostomy Tube: A nephrostomy tube drains urine directly from your kidney into a drainage bag. It is routinely placed to tamponade bleeding from the tract between the skin and the kidney. Urine from the kidney is often blood-tinged and will clear over the ensuing days following surgery. There is a possibility that you will be discharged from the hospital with the nephrostomy tube as deemed necessary by your surgeon. The nephrostomy tube will then be removed in the office at the bedside generally 1-2 weeks following surgery.
• Ureteral Stent: A ureteral stent is a small flexible plastic internal tube that is placed to promote drainage of your kidney down to the bladder. This will be removed in your surgeon’s office in typically 1-2 weeks following surgery.
• Nausea: Often patients experience transient nausea the first day or two following surgery under general anesthesia.Medication is available to treat persistent nausea.
• Urinary Catheter: A bladder catheter called a foley is placed in the operating room while you are asleep and left in place for approximately one day after the surgery. This allows your surgical team to continuously monitor your urine output. It is not uncommon to have blood-tinged urine for a several days after surgery.  The catheter will be removed prior to discharge.
• Diet: Your diet will be advanced slowly from clear liquids to solid foods as tolerated over the first two days following surgery. In addition, intravenous fluids will be administered to keep your body well hydrated following surgery. Most patients, however, will not regain their appetite until they are discharged and at home.
• Fatigue: Fatigue is common and should start to subside in a few weeks to a month following surgery.
• Incentive Spirometry: Deep breathing exercises are important in reducing the incidence of pulmonary complications such as pneumonia. These exercises will be performed with the use of an incentive spirometer, which your nurses and surgical team will explain how to use.
• Physical Activity: On the evening of surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can also expect to have SCD’s (sequential compression devices) to prevent blood clots from forming in your legs. During your hospital stay it is advised that you walk at least 4-6 times in the hallways per day to minimize risks of clots.  The more walking you can tolerate the better.
• Activity: Taking daily walks is advised to minimize blood clots, called a deep vein thrombosis, from forming in your legs. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible, however, should be taken slowly. Driving should be avoided for at least 1-2 weeks after surgery and only after narcotic pain medications have been stopped. After this time, activity can begin as tolerated. You can expect to return to work as soon as 1-2 weeks following surgery or as instructed by your physician.
• Hospital Stay: The length of hospital stay for most patients is approximately 1-2 day.
• Secondary Procedures: On occasions, a second PCNL procedure may be required as a “second look” procedure through the original nephrostomy tract to retrieve any retained stone fragments. This procedure may be performed during your hospitalization or at a second surgery date as determined by your surgeon.

Follow up

The ureteral stent is generally removed within 1-2 weeks following surgery and will be determined by your surgeon. While your stent is in place, it is common to feel a slight amount of flank fullness and urgency to void as a result of the stent. These symptoms often improve over time as the body adjusts to the indwelling stent. The stent is removed by cystoscopy during which time your surgeon will place a small flexible telescope into the urethra to visualize and grasp the terminal end of the stent that rests in your bladder. This generally takes less than a couple of minutes to perform.

Frequently asked question

What is the recovery time for percutaneous nephrolithotomy?

You may stay in the hospital for one or two days after the procedure. Your doctor will recommend that you avoid heavy lifting, and 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'll need to watch for any bleeding.

Is Pcnl safe?

Multiple tracts PCNL is safe and effective in achieving a great stone clearance rate with non-significant blood loss and a minimal need for blood transfusion.

Does stent removal require anesthesia?

Most patients tolerate having the stent removed using only a topical anesthetic placed in the urethra. Immediately before the procedure, sterile lubrication containing local anesthetic (lidocaine) is instilled into the urethra.

Why are kidney stents so painful?

The cause of the pain is swelling in the tube connecting the kidney to the bladder. Taking your pain medications may be required to alleviate this pain, which may be severe in nature.

Do and don'ts after stent?

Don't lift heavy objects. Avoid strenuous exercise. Avoid sexual activity for a week. Wait at least a week before swimming or bathing.

What are the signs of stent failure?

Sometimes heart problems return after a stent procedure. If that happens, you usually have symptoms—like chest pain, fatigue, or shortness of breath. If you do have symptoms, ask your doctor.

What percent of blockage requires a stent?

An artery should be clogged at least 70 percent before a stent should be placed. A 50 percent blockage doesn't need to be stented.