Percutaneous nephrolithotomy

Introduction
Percutaneous nephrolithotomy is one of the methods for treating kidney stones and ureteral stones. This operation is performed using a minimally invasive approach, where medical instruments are passed through the skin into the kidney to remove the stones.

Surgical procedure

1. The entire procedure must be performed under X-ray and/or ultrasound monitoring.
2. The doctor will first examine the bladder with an endoscope and inject a contrast agent into the ureters via a catheter.
3. The doctor will make a small cut in the back/side of the body to insert a fine needle through the skin and into the kidney. The channel for the fine needle will then be widened.
4. The instrument will enter through an enlarged duct. The doctor will first use the instrument to break up the stones, and then remove the fragments.
5. After surgery, a nephrostomy tube and urinary catheter are usually inserted, and a ureteral stent may be placed as needed.

Risks and complications
Common risks and complications
As with other minimally invasive treatments, percutaneous nephrolithotomy also carries certain risks:

• Bleeding
• Infection
• The wound is painful
• Residual stones, requiring repeat surgery or further stone treatment

Uncommon risks and serious complications
Potential uncommon risks include:

• Damage to neighbouring organs, including: gastrointestinal perforation (<1%), pleural cavity and lung perforation (1–3%), and spleen and liver perforation
• Urinary tract damage
• Blood transfusions (10–30%), radiological or surgical interventions (1–3%) may be required due to haemorrhage leading to haematoma and retained clots. If the bleeding is severe or does not improve following these procedures, a nephrectomy may be necessary.
• Failure to establish a pipe or inability to remove gallstones
• Stone fragments falling into the ureter causing obstruction.
• Converted to open surgery or other interventional surgery
• Sepsis (1–2%)
• Impaired or failing kidney function
• Death (<0.5%)

This does not list rarer complications.

Pre-operation

1. If you are pregnant, please inform your doctor.
2. Please inform the doctor of any medical conditions (e.g. diabetes, heart disease, high blood pressure) and any medications you are currently taking (especially blood thinners).
3. The doctor will assess whether you are suitable for surgery.
4. Undergo pre-operative checks, including: blood tests, urine tests, and X-rays.
5. You must not eat or drink for at least 6 hours before your operation, or as directed by your doctor.
6. The doctor will inform you whether to continue your regular medication during your fasting period and provide other instructions.
7. The doctor will prescribe preventative antibiotics for you to minimise the risk of infection.

Post-operation

• Doctors and nurses will closely monitor your blood pressure, pulse, signs of bleeding, and pain levels.
• Mild pain may occur at the incision site.
• You may need to receive an intravenous drip, and once your condition improves, you will be able to resume a normal diet.
• It is recommended to perform deep breathing and coughing exercises to prevent lung infections.
• Urine in the renal drain and urinary catheter will be blood-streaked for several days.
• If the situation permits, the doctor will remove the nephrostomy tube and urinary catheter as soon as possible.
• If a ureteral stent was placed during your surgery, please remember to return to the hospital at your scheduled appointment to have it removed.
• Follow-up appointments will be arranged for your discharge if the doctor deems it appropriate. After discharge, please follow the instructions for wound care and follow-up appointments.
• If any serious condition occurs after discharge, please go to the nearest emergency department.

Remarks
This leaflet provides only basic information about the surgery. Not all possible risks or complications can be fully listed. The level of risk also varies for individual patients. Please contact your doctor if you have any questions.

Source: https://www.ekg.org.hk/pilic/public/surgery_pilic/urosurg_percutaneousnephrolithotomy_0197_chi.pdf