Kidney stone surgery is a procedure that involves the surgical removal of crystallized stones in the kidneys. Kidney stone surgery performed considering the size and location of the stone in the kidney is performed endoscopically, i.e. with closed surgery.
In the removal of kidney stones, endoscopic surgery is preferred to open surgery all over the world. The operation is performed accessing the kidney through an incision made in the back of the patient.
Percutaneous Nephrolithotomy (PNL)
Percutaneous Nephrolithotomy (PNL) is the medical name of kidney stone surgery. PNL performed through a small surgical incision provides advantages such as the possibility of rapid recovery. However, patients with the following conditions are not suitable candidates for PNL surgery:
- untreated urinary tract infection
- high risk of bleeding during a surgical operation
In PNL surgery, the stones in the kidney are located by x-ray. Operations are performed under general or epidural anesthesia.
Percutaneous Nephrolithotomy surgery is classified into 4 types based on the size of the canal, through which the stone is accessed:
- Micro PNL: The enlargement process is carried out up to 2 mm.
- Ultra-mini PNL: The enlargement process is carried out up to 4 mm.
- Mini-PNL: The enlargement process is carried out up to 5-7 mm.
- Standard PNL: The enlargement process is carried out up to 8-10 mm.
One of these 4 types of PNL is preferred depending on the size, location, and structural features of the kidney stone. With the PNL method chosen, the stone in the kidney is removed and its recurrence is prevented.
Kidney stone surgery has 2 stages after anesthesia.
First Stage: A cystoscope is inserted through the patient’s urethral orifice. A tube (catheter) is placed in such a way as to access the kidney where the stone is located. A contrast agent is injected into the kidney so that the X-rays can make the kidney visible on radiograms.
Final Stage: With the help of a special needle, a thin wire is inserted into the kidney, where the X-rays showed kidney stones. Thanks to this wire, a tube with a diameter of 1 cm is placed in the kidney. A 30 cm long instrument called a nephroscope is inserted through this path. Nephroscope is equipped with an illuminated system. This instrument enables the surgeon to see inside the patient’s kidney. Another rod passed through the nephroscope crushes the stones. Stone pieces are then taken out by the basket or vacuum system.
The nephrostomy procedure is performed on the patient who has had PNL surgery. In other words, a catheter intended for urinary drainage is placed in a part of the patient's abdomen near the back. A wire called double J is placed in patients who have not had bleeding after PNL. There is no need to perform the nephrostomy catheter procedure for patients with Double J.
After Kidney Stone Surgery (PNL)
A urinary catheter is inserted into the patient's bladder after surgery. This catheter is removed on the first day after the surgery.
If the patient does not have postoperative bleeding and a Double J catheter has been inserted, he/she can be discharged the next day. The inserted Double J catheter is removed at the end of the 1st postoperative month.
At the end of the first month after surgery, radiography is performed to check whether there are any remaining pieces of stone in the kidney.
In some cases, patients may experience postoperative urinary incontinence. This condition is expected to be a self-resolving problem.
Risks of PNL Operation
PNL surgery gives very successful results in crushing kidney stones but carries some risks. Mostly the doctor is able to minimize such risks and prevent complications in the patient.
An experienced urologist can completely save his patient from kidney stones by performing PNL surgery. In inexperienced hands, PNL is likely to give undesirable results.
Bleeding may be observed after surgery. A blood transfusion may be needed depending on the intensity of the bleeding.
If bleeding occurs in the kidney operated (the incidence is 2/1,000), kidney angiography is performed and bleeding is stopped. If the condition gets worse, surgical removal of the bleeding kidney may be required.
In rare cases, the bacteria in kidney stones can mix with blood. Such a condition causes infection. In the worst-case scenario, the patient may fall into a coma. (the incidence is 1 percent)
In rare cases, intestinal injuries may occur during surgery. In such a case, additional surgery is needed to repair the intestines. (the incidence is 1/1,000)