Advice after your nerve block for surgery
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Introduction
We have been advised by your hospital consultant that you need to have a Percutaneous Nephrolithotomy (PCNL) procedure. This information tells you about having a PCNL, what is involved, and what the possible risks are.
This leaflet may not answer all your questions, so if you have any queries or concerns,
please contact us using the telephone number on your appointment letter, or ask the ward staff.
What is PCNL?
Whilst many small kidney stones can be treated using a shock wave machine
(Extracorporeal shockwaves lithotripsy (ESWL)), large stones are not suitable for this form of treatment. PCNL ("keyhole" removal) is a keyhole surgical technique used for larger stones in the kidney or stones which are in a position that makes them inaccessible to being extracted via the bladder. This is a way to remove kidney stones which is less invasive than an open operation and allows you to recover much more quickly. The PCNL will be performed by a radiologist (doctor specialising in medical imaging) with a urologist (doctor specialising in the kidney and urinary tract) who will be assisted by a radiographer and radiology/theatre nurses. The radiologist will use ultrasound and fluoroscopy imaging to be able to safely access the kidney for a urologist to be able to break up and remove the stone.
What is Fluoroscopy?
Fluoroscopy is a process that uses X-rays to produce a real time moving image on a
television monitor.
What is Ultrasound?
An ultrasound scan is an examination that uses sound waves to take pictures of the part of the body being examined. It does not involve X-rays.
Before your appointment
You will need to attend for a pre-op assessment appointment before your surgery, having already filled out a health screening questionnaire. This is to check that you are fit and well enough to have your operation. You may have blood tests as well as other investigations such as a urine test, heart tracing (ECG) or chest x-ray at this appointment.
Please let us know if:
- you are taking any medication which impair the bloods ability to clot (anticoagulation or blood thinning drugs) e.g. Warfarin or clopidigrel, or, if you are aware that you may have bleeding problems. The radiologist who will be performing your examination can be notified and may need to discuss this with you and your hospital consultant before your appointment can be confirmed as the medication may need to be stopped or changed before the procedure
- • you have limited mobility and will require assistance to get on and off the scanner.
- you will need an interpreter. We are not able to use family members or friends to interpret.
- there is any possibility that you may be pregnant. All patients from 12-55 years of age (regardless of gender) who will undergo a Radiology procedure will be asked about the possibility of them being pregnant.
- you are diabetic - please note that you are required to starve before the examination.
Please do not eat or drink anything, except a little water if necessary, for six hours before your appointment.
What to bring with you
You will usually be admitted for the procedure. For this reason we advise that you prepare an overnight bag and bring this with you. You may wish to bring your own dressing gown, slippers and reading material.
Please bring with you to your regular medications you are taking
During the procedure
Referral and consent
You will be asked to sign a consent form confirming that you understand the procedure and are aware of the risks and benefits involved. Where practical this is usually done on the ward or in an outpatient clinic environment before your admission to hospital for the procedure.
The PCNL is normally done as a planned procedure and you should have plenty of time to discuss the situation with your doctor or the nurse specialist looking after you before you sign the consent form. When you arrive for the procedure you will also discuss the procedure with the radiologist/urologist who will be performing the procedure who will again sign the consent form with you.
If after discussion with your hospital doctor, you do not want the procedure carried out, then you can decide against it. If the radiologist feels that your condition has changed or that your symptoms do not indicate such a procedure is necessary then they will explain this to you and they will communicate with the referring doctor who will review your situation as soon as possible. At all times the radiologist and referring doctor will be acting in your best interests.
Procedure
The procedure is carried out under a general anaesthetic, so you will need to be admitted to the hospital as an in-patient for this procedure.
After the anaesthetist has administered the general anaesthetic and you are asleep, the Radiologist will use the ultrasound and x-rays to guide a small needle into your kidney. Once the Radiologist is sure the needle is in a satisfactory position, a guidewire can be placed in the kidney through the needle and larger tubes are placed over the wire, so that a suitable track is created between the skin and the part of the kidney next to the stone. The Urologist is then able to pass a ‘telescope’, called an endoscope down the track and see the stone to remove it. At the end of the procedure a plastic drainage tube called a catheter may be left in the kidney through the original track (nephrostomy) to allow urine to drain into a bag as a temporary measure or an internal stent is placed with one end in the kidney and the other in
the bladder. There may also be a catheter to drain urine from the bladder.
After the procedure
You will be taken to the operating theatre recovery area.
You will be taken to the operating theatre recovery area. Routine observations will be carried out to make sure there are no problems. Once you have returned to your ward, nurses will continue regular observations, such as taking your pulse, blood pressure and temperature, to make sure that there are no problems. You may be required to stay in bed for at least four hours. You should tell the nurses if you feel worsening pain or a rise in your body temperature.
The bladder catheter is usually removed on the first morning after surgery. An x-ray
investigation following injecting dye down the nephrostomy tube will be planned for the third post-operative day in the radiology department and if the kidney is draining well this tube will be removed. There may be some leakage of urine for a short while after the tube has been removed but most patients will be discharged later the same day. Occasionally the x-ray shows that the kidney is not draining in which case you will be discharged with the drain in place to allow any internal swelling to settle. The nurses will teach you how to look after the tube and a repeat x-ray will be booked later.
You are advised to avoid heavy lifting or driving for 2 weeks following surgery, however light activity such as walking is advised. You can return to work when you feel fit and able, depending on what sort of work you do. Most people should be back to full physical activity 3-4 weeks after surgery.
Risks
As with any procedure or operation, complications are possible. We have included the most common risks and complications in this leaflet. The possibility of these occurring will vary for each patient and the possibility of these happening to you will be discussed with you, before you sign the consent form.
Bleeding: Any procedure carries a small risk of bleeding. On rare occasions, this may
become severe and require an operation or another radiological procedure to stop it. There may be soreness around the access site and some bruising.
Infection: Occasionally there may be infection in the kidney or the area surrounding the PCNL site. This can usually be treated with antibiotics.
Damage to underlying tissues: Rarely, as the biopsy needle passes through the body to the target area, surrounding tissues may be damaged.
Urinary leak: Sometimes there is a small leak of urine from the kidney, resulting in a small collection of fluid inside the abdomen. If this becomes a large collection, it may require draining.
Unfortunately, not all PCNL procedures are successful. This may be because, in spite of taking every possible care, the stone still cannot be accessed.
X-rays are a type of radiation. We are all exposed to natural background radiation every day from the sun, food we eat, and the ground. Exposure to medical X-rays carries a small additional risk, but your doctor feels that this risk is outweighed by the benefits of having the test and the amount of radiation you will receive is kept to as low as reasonably possible.
Contact us
If you have any queries relating to this information, please contact the Radiology service.
About this information
Service:
Radiology
Reference:
PILS-IR.22
Approval date:
2 October 2024
Review date:
2 October 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.