Percutaneous nephrolithotomy (PCNL) Melbourne

Sometimes a procedure called Percutaneous Nephrolithotomy is recommended to remove a stone.

We often use this procedure when the stone is quite large or in a location that does not allow effective use of ESWL. The surgeon makes a tiny incision in the back and creates a tunnel directly into the kidney.

Using an instrument called nephroscope, the surgeon locates and removes the stone. For large stones, a vibrating probe (like a pneumatic drill) is used to break the stone into small pieces. Generally, you stay in hospital for a few days and may have a small tube called a nephrostomy tube left in the kidney during the healing process. One advantage of percutaneous nephrolithotomy over ESWL is that the surgeon removes the stone fragments instead of relying on their natural passage from the kidney. The surgery takes 2-3 hours and you will be in hospital for 3-4 days.

Before your surgery

You are required to have the following tests:

• Pathology – Urine culture and bloods (including Full blood examination, urea and electrolytes and prothrombin time
• Radiology – Abdominal X-Ray of kidneys, ureter and bladder, Renal Ultrasound and Renal CT scan

If your urine culture indicates an infection, you will be prescribed antibiotics before your surgery. If you are taking anticoagulants (blood thinning medication), please inform your surgeon or Practice Nurse as soon as possible as you will need to stop these before surgery.

Following your surgery and whilst you are in hospital

• You will be given regular pain relief.
• A nephrostomy tube is left in place to drain the urine. Arrangements will be made with your surgeon to have this removed before you are discharged from hospital.
• You will have a urethral catheter to drain the bladder. This is also removed before you are discharged from hospital.
• On infrequent occasions a ureteric stent may also be required.
• Your urine may be blood stained and this may continue for 1-2 weeks.

Following discharge from hospital

• You are advised to take regular pain relief as required.
• Gentle exercise such as walking is advised. Avoid any strenuous physical activity
• You will be unable to drive for approximately 7-10 days.

You must call the rooms on 03 9457 4445 and speak to the Practice Nurse if you experience any of the following:

• Excruciating pain when passing urine not relieved by oral analgesia
• Fever
• Wound sites – red, inflamed/swollen and hot to touch
• Urine – offensive, presence of frank blood, passing of clots
• Nausea, general malaise