Percutaneous Nephrostolithotomy (PCNL) Percutaneous Nephrostolithotomy (PCNL) is an excellent modality of therapy for the treatment of kidney stones greater

than 2cm in size, staghorn calculi , large lower pole stones or patients with anatomic abnormalities of the kidneys precluding treatment with ureteroscopy. PCNL is a more invasive method of treatment and removal of kidney stones involving creating an acess point into the kidney via the skin through a patients flank. A larger access sheath is placed into the kidney allowing the passage of a larger camera (nephroscope) and stone fragmenting devices. Using PCNL, the goal is to completely fragment large stones and pull all of the pieces out of the access sheath so that they do not have to pass down the ureter. A nephrostomy tube is commonly left at the end of the procedure to allow maximum drainage of the kidney. General anesthesia is used and a patient may have to spend 1-3 days in the hospital to recover.

Most kidney stones will be small enough (no more than 4mm or 0.2in in diameter) to be passed out in your urine. It may be possible to treat these at home. However, small kidney stones may still cause pain. The pain from smaller kidney stones usually lasts a couple of days and disappears when the stone has been passed. Medication If you have severe pain, your GP may inject you with a painkiller. A second dose can be given after half an hour if you are still experiencing pain. Medication can also be injected to treat the symptoms of nausea (feeling sick) and vomiting. This is called an anti-emetic (anti-sickness) medication.

You may also be given a prescription for painkillers, anti-emetics or both, to take at home. Self care If you are sent home to wait for your kidney stone to pass, you may be advised to try to collect the stone from your urine. You can do this by filtering your urine through gauze or a stocking. The stone can be given to your GP to help them determine any further treatment you may need.

You should drink enough water to make your urine colourless. If your urine is yellow or brown you are not drinking enough. See the box to the right for advice about when to seek urgent medical attention if you are treating your kidney stones at home.

Treating large kidney stones

If a kidney stone is too big to be passed naturally (6-7mm in diameter or larger), you may need to have treatment to remove it another way. This could include:

extracorporeal shock wave lithotripsy (ESWL) ureteroscopy percutaneous nephrolithotomy (PCNL) open surgery

These procedures are explained in more detail below. The type of treatment you have will depend on the size and location of your stones. Extracorporeal shock wave lithotripsy (ESWL) ESWL is the most common way of treating kidney stones that cannot be passed in the urine. It involves using X-rays (high-energy radiation) or ultrasound (high-frequency sound waves) to pin-point where a kidney stone is. A machine then sends shock waves of energy to the stone to break it into smaller pieces so it can be passed in your urine. ESWL can be an uncomfortable form of treatment, so it is usually performed after giving painkilling medication. You may need more than one session of ESWL to treat your kidney stones successfully. For stones that are up to 20mm (0.8in) in diameter, ESWL is up to 99% effective. Ureterorenoscopy If a kidney stone is stuck in your ureter (the muscular tube that carries waste products from your kidneys to your bladder), you may need to have ureterorenoscopy. Ureterorenoscopy is also sometimes known as retrograde intrarenal surgery (RIRS). Ureterorenoscopy involves passing a long, thin telescope, called a ureteroscope, through your urethra (tube that carries urine from the bladder to the outside of the body) and into your bladder. It is then passed up into your ureter to where the stone is stuck. The surgeon may either try gently to remove the stone using another instrument, or they may use laser energy to break the stone up into small pieces so that it can be passed naturally in your urine. As with PCNL, ureterorenoscopy is also performed under general anaesthetic, so you should not drive or operate machinery for up to 48 hours after the procedure. For stones up to 15mm (0.6in), an ureterorenoscopy is effective in 50-80% of cases. You may need a plastic tube called a stent to be inserted temporarily inside you, to allow the stone fragments to drain into the bladder.

Percutaneous nephrolithotomy (PCNL) PCNL is an alternative procedure that may be used for larger stones. It may also be used if ESWL is not suitable, for example because the person being treated is obese. PCNL involves using a thin telescopic instrument that is called a nephroscope. An incision (cut) that leads to your kidney is made in your back. The nephroscope is passed through the incision and into your kidney. The stone is either pulled out, or broken into smaller pieces using a laser or pneumatic energy. PCNL is always performed under general anaesthetic (you are put to sleep), which means that you should not drive or operate machinery for up to 48 hours after the procedure. For stones that are 21-30mm (0.8-1.2in) in diameter, PCNL is 86% effective. Open surgery Nowadays, it is rare for people to have open surgery for kidney stones (less than 1% of cases require this type of surgery). It is usually used if there is a very large stone or abnormal anatomy. It involves making an incision (cut) in your back to gain access to both your ureter and your kidney. The kidney stone can then be removed.

Treating uric acid stones

If you have a uric acid stone, you may be advised to drink around three litres of water each day to try to dissolve it. Uric acid stones are much softer than other types of kidney stone, and they can be made smaller if they are exposed to alkaline fluids. You may need to take some medication to make your urine more alkaline before the uric acid stone starts to dissolve.

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Comments
The 2 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Pablo CR said on 11 February 2013

I was twice at A&E department at Kings College Hospital for a kidney stone that is to big to pass and got blocked in my urethra, I was inserted a catheter and I was sent home, the urologist told me to wait for her phone call for a Day Surgery, but since 29th of January I haven't got any call. I went to PALS and the adviser contacted Urology Ward, nobody knew about my case, or who the lady urologist was on that day. I hope someone is going to read this comment and give me some advice. Thanks. Report this content as offensive or unsuitable

leftbehind said on 19 January 2013

Medication If you have severe pain, your GP may inject you with a painkiller. A second dose can be given after half an hour if you are still experiencing pain. On what planet will this happen? It takes two weeks to see my GP!!!!