PERCUTANEOUS NEPHROLITHOTOMY /NEPHROLITHOTRIPSY

What are percutaneous nephrolithotomy and percutaneous nephrolithotripsy? These procedures are treatments for kidney stones that are used in patients with large or irregularly shaped kidney stones, people with infections, stones that have not been broken up enough by SWL (extracorporeal shock wave lithotripsy ) or those who are not candidates for another common stone treatment,ureteroscopy. Stones that are bigger than 2 cm (the size of a marble) require this procedure.

Both procedures involve entering the kidney through a small incision in the back. Once the surgeon gets to the kidney, a nephroscope (a miniature fiberoptic camera) and other small instruments are threaded in through the hole. lf the stone is removed through the tube, it is called nephrolithotomy. lf the stone is broken up and then removed, it is called nephrolithotripsy. The surgeon can see the stone, use high frequency sound waves to break up the stone, and "vacuum" up the dust using a suction machine.

This is what the words mean:

• Percutaneous means through the skin
• Nephrolithotomy is a combination of the word roots nephro- (kidney), litho-(stone) and -tomy (removal)
• Nephrolithotripsy is a combination of the word roots nephro- (kidney), litho (stone), and -tripsy (crushed)

Will I be hospitalized for this procedure?

Yes. This requires a general anesthesia. You will need a short (2 or 3 day) hospitalization. You may be off work for a week or so. Depending on the position of the stone, the procedure is completed in 20 to 45 minutes. The goal is to take out all of the stones so that none are left to pass through the urinary tract.

What are the risks?

Even minimally invasive surgeries, like percutaneous nephrolithotomy or nephrolithotripsy, carry risks of infection, bleeding, and other complications. The procedure creates a hole in the kidney that usually heals without other treatment. Operations on the abdomen carry a small risk of injury to other nearby organs, such as the bowel, the ureter, the liver or the bladder.

ls it my only option?

When stones are very large (more than 2 cm) or in a location that does not allow effective SWL or ureteroscopy, Any operation on the kidney carries a relatively rare long term risk of high blood pressure or reduced kidney function later in life. You should talk with your surgeon about this. percutaneous stone removal may be needed. lt often avoids the need for more invasive open surgery, which is another option for these stones, but that is only very rarely needed.

What are the advantages and disadvantages?

One advantage of this surgery is that it is the most effective technique for making sure a patient is stone-free. Most patients leave the hospital stone free. Occasionally, though, another procedure will be needed to remove a stone.

Even though it involves an incision, it is less invasive than a full open surgery to treat the kidney stone. Because it is among the more difficult surgeries, it is performed by surgeons with specialized training. Urologists and radiologists may work together on these surgeries.