Percutaneous Nephrolithotomy (PCNL)
When is this procedure indicated?
Percutaneous nephrolithotripsy is usually offered to patients with voluminous and complex kidney stones, in whom a pure endoscopic retrograde approach would not guarantee a good result in terms of complete remediation of the lithiasic mass.
In particular, it is the preferred procedure for kidney stones larger than 2 cm, while it assumes a less relevant role in smaller kidney stones.
How is it performed?
This technique allows direct access to the intrarenal cavities and calculus by puncturing the kidney and creating a link between the skin and the renal parenchyma. Once the access to the intrarenal cavities has been created, a dilation of the passageway is performed (up to 1 cm as maximum diameter) that allows the insertion of the operating instruments, i.e. the nephroscope, to navigate inside the renal cavities in search of the stone, and then the lithotripsy probes (ballistic, ultrasonic, Holmio laser) used to fragment the stone and then remove the remaining fragments with forceps and baskets.
In the last few years, very small operating instruments have been developed that work through a very small (about 3-5 mm) vessel and allow to perform the so-called mini-LP, limiting the risk of complications and bleeding with comparable success rates but at the price of longer duration of surgery. The choice of technique to be used is always agreed and shared with the patient before the intervention, after a careful analysis of each case. The surgery is performed under general anesthesia, and the patient can be positioned prone or supine depending on the needs and characteristics of the operation.
The average hospital stay after percutaneous lithotripsy is about 3-4 days, and depends on the general condition of the patient and the complexity of the procedure, with a full return to work usually occurring after one week.
Like any surgical procedure, percutaneous nephrolithotripsy is also associated, although in a limited percentage, with complications.
Data in the literature show that the following may occur: fever (10.8%), need for transfusion (7%), pleural injury (1.5%), systemic infection (sepsis, 0.3-4.7%), adjacent organ injury (colon, liver, spleen - 0.4%), need to embolize renal bleeding sources (0.4%), peri-operative mortality (0.05%).
Reduced kidney function can be a long-term complication, especially if embolization of arterial vessels of the renal parenchyma becomes necessary due to post-operative bleeding that does not resolve spontaneously.