What is Percutaneous Nephrolithotomy (PCNL) Surgery?
What is PCNL? Percutaneous Nephrolithotomy (PCNL) surgery is the most used method among kidney stone treatment options. It is an endoscopic (closed) kidney stone surgery performed through an incision of approximately 1 cm from the back, usually in stones larger than 2 cm. The advantage of kidney stone surgery, that is, PCNL surgery; because it is made through a small incision, it significantly reduces the patient’s hospital stay and recovery time compared to open surgery. With this method, patients can get up in a day and return to their normal lives in a few days at the most.
How is Percutaneous Nephrolithotomy (PCNL) Applied?
In Percutaneous Nephrolithotomy (PCNL) surgery, the surgeon reaches the stone whose position is determined in the radiological examination with the help of a needle. For this, a hole with a diameter of about 10 mm is drilled from the patient’s back quarter. The kidney stone is reached through this hole with the help of an instrument called a nephroscope. The stone is broken into pieces and taken out of the body. After all the stones are cleared, a tube (nephrostomy) with one end in the kidney and the other outside the body is attached to the patient. This tube is removed before the patient is discharged. Although the processing time may vary according to the size of the stone, it takes a maximum of 2 hours.
Which Stones Can Be Applied To?
In cases where the kidney stone is larger than 2 cm, the most preferred method is PCNL. As we mentioned, PCNL is a surgical intervention and is applied by making a small hole in the back of the patient. The technology that has developed over the years has offered us many different treatment alternatives instead of PCNL. However, these alternatives are mostly valid for small kidney stones:
With ”Extracorporeal Shock Wave Lithotripsy” (ESWL) technology, kidney stones smaller than 2 cm can be broken with shock waves from outside the body.
In the URS method, stones below 2 cm can be successfully intervened by entering through the urinary hole without making an incision in the body.
The RIRS method, on the other hand, can be a partial alternative to PCNL in large stones. As in URS, the stone is reached by entering through the urinary hole. The procedure is performed with a tiltable ureteroscope. The stones broken with the help of laser are taken out of the body with a basket. It can be applied by experienced surgeons in stones up to 3 cm.
Advantages over Other Methods
It can be applied to any size kidney stone. The size of the stone does not lead to a problem.
The process is completed in a single session. Very rarely, a second operation is applied.
The success rate in stone treatment with PNL is higher than 90%. Contrary to ESWL, a stone-free kidney is possible after the operation, since the stone is not expected to be broken and excreted through urine.
It can be applied to hard stones that are difficult to break.
It has its own alternatives. It is possible to use a smaller nephroscope according to the size of the kidney stone. In this way, faster healing is achieved and the hole opened in the body is also much smaller.