In PCNL or closed kidney stone surgery, the surgeon makes a very small incision in your back to extract the stones inside the kidney. He then inserts a hollow tube (catheter) into the kidney through this slit, and then inserts a special stone-breaking tube into the kidney through this tube, and after breaking the stones, removes them from the kidney through the said tube. General, local or spinal anesthesia may be used to perform this procedure. Another very narrow tube may also be inserted into the kidney to drain urine from the kidney during the operation. This method is used to treat kidney stones with the following characteristics: • More than 2 cm (0.8 inch) in diameter • Large stones caused by infection • Stones that have blocked the flow of urine out of the kidney. Stones that have not been broken by ESWL or extracorporeal lithotripsy
Advantages and Disadvantages
What are the advantages of this method? • With the help of this method, large stones or stones with a complex structure that have caused kidney pain can be removed from the kidney in a minimally invasive way. In the past, to do such a job, it was necessary to make a large incision in the side and stay in the hospital for a long time. • In this method, the duration of hospitalization is 2 to 4 days, and the recovery time of the patient after discharge from the hospital is also much less than the old surgical method. • With the help of this method, the patient can return to work and daily activities much faster. What are the disadvantages of this method? Compared to the old technique of treating large stones or stones with a complex structure, the PCNL technique has no disadvantages or disadvantages. The improvements made in this surgical technique as well as the new tools used in this method have made it possible for highly specialized surgeons to perform this surgery much more safely.
Types of PCNL PCNL
in the usual way PCNL surgery to treat kidney stones usually involves several steps that are performed over several days. • On the first day, with the help of a tube, a narrow path is opened to the kidney and the doctor tries to remove all the stones inside the kidney through it. During this procedure, a nephrostomy tube (a soft plastic tube that enters the kidney from the waist) is inserted into the kidney so that the urine fluid is removed from the body through it. • The day after this surgery, a CT scan is performed to identify the remaining stones in the kidney (if any). • If there is a stone left in the kidney, it will be removed from the kidney during the second (or third) surgery that is performed through the same way as the previous one. In some cases, it may be necessary to open another way to the kidney to be able to access the desired stone. • When all the stones are removed from the kidney, the colored contrast liquid for X-ray imaging is injected into the kidney through the nephrostomy tube so that it can be completely sure that there are no stones left in the kidney with the help of imaging. If it is determined in the imaging that all the stones have been completely extracted, the nephrostomy tube will also be removed from the body. If the urine does not leave the kidney well, the nephrostomy tube may be left in place for a few days or an internal catheter may be placed for the patient to allow the ureter and kidney to fully recover. Tubeless PCNL During this operation, the stones are removed from the kidney in the same way as before. The difference between this method and the previous method is that in the final stage, the urologist will place a ureteral stent instead of the nephrostomy tube if he is sure of the complete cleansing of the kidney. If all the stones cannot be removed from the kidney or if a lot of bleeding occurs during the surgery, the surgery is performed using the usual PCNL method. What preparations are necessary
before the treatment
Before surgery, special imaging of the kidney should be done so that your surgeon can determine the exact location and location of the stones. With the help of these photographs, the surgeon can understand the three-dimensional position of the stones and mark the important tissues or structures that are next to the stones to consciously avoid damaging them. With the help of these evaluations, the surgeon can determine the best place to access the kidney to perform effective surgery. This surgery is performed under general anesthesia, so you should not eat or drink anything for 6 hours before the surgery. You can take the medicines you need to take with a small sip of water. You should stop taking blood thinners or nonsteroidal anti-inflammatory drugs 7 to 10 days before surgery. The surgeon will give you detailed information about the medications you should or should not take before surgery. Before surgery, an MSU (midstream urine sampling) urine test is performed to ensure that there is no infection in the urine and that the urine fluid is sterile. Other tests you may need to have include kidney function tests, complete blood counts, and blood clotting tests. All the tests you have to do before the surgery are planned during the consultation with the doctor. What should I bring with me for the operation
All tests and imaging performed related to your surgery, such as X-rays, CT scans, and kidney ultrasounds. • Medicines you take. What happens in the operating
room
This surgery is performed under general anesthesia and takes between 2 and 3 hours. This operation is performed by a team consisting of a surgeon, an anesthesiologist, a radiography technician and a nursing team who work together harmoniously. During the surgery, you will be placed on the operating bed. During surgery, X-ray or ultrasound images are used simultaneously so that the surgeon can guide the tube that is going to enter the kidney in the right direction. After the tube is inserted into the kidney, other surgical tools, including telescopes, fiber optics, and tools for removing broken stones, are inserted into the kidney through the tube. At the end of the surgery, a narrow plastic tube called a nephrostomy, which is inside the kidney and exits through the skin, may remain in the body to drain urine and other excess fluids from the kidney. Surgery is also used to treat bladder stones.
After surgery
After the surgery, you may still have another narrow tube called a nephrostomy in your body. It is inside the kidney and exits through the skin. Also, a ureteral catheter may be inserted into the bladder to drain urine through it. These two tubes (catheters) will be removed from your body before you are discharged from the hospital. Urine fluid may be mixed with blood for up to a week after surgery, which is normal, unless the amount of blood in the urine increases. Immediately after the surgery, the kidneys are photographed to detect the presence of remaining stones in the kidney. Your stay in the hospital is between 2 and 4 days. In some cases, where there are still stones left inside the kidney, surgery is performed again with pyeloscopy and laser to extract the remaining stones and clean the kidney completely. For patients who have a ureteral stent after surgery: • They may need to urinate frequently. • He may have side and back pain while urinating. • They may feel pain in their bladder near the end of urination. For patients with a nephrostomy tube: • It is painful to sleep on the side where the nephrostomy tube is located. • Urinary fluid may leak out from around the location of the nephrostomy tube. • After the tube is removed, urine may leak out for a day or two. • The incision made on the back may be a little annoying and have a slight pain, but it should not be severe. • Up to a month after surgery, it is normal to feel tired.