Issued May 2012, reviewed by Urology Nurse Practitioners, Urology Consultants, Ward Sister.

Next review date May

2014
Page 1 of 4




Department of Urology

HAVING A PERCUTANEOUS NEPHROLITHOTOMY (PCNL)

Percutaneous nephrolithotomy (PCNL) is a procedure used to remove stone(s)
from the kidney using keyhole surgery. Percutaneous means through the skin and
nephrolithotomy means taking stones out of the kidney.
Only certain types of stone are suitable for this procedure.

Why do I need a PCNL?

Kidney stones can be very painful, and if left untreated may become bigger,
leading to infection and impaired kidney function. Your urologist believes that you
need to have your kidney stone removed in this way. It may be that you have failed
other sorts of treatment such as lithotripsy (shock wave therapy) or that your stone
is most suited to percutaneous surgery.

What are the alternatives?

External shock wave treatment. Open surgical removal of stones, observation.

What preparations should be made before your operation

You will receive an appointment for pre-assessment to assess your general fitness,
to screen for MRSA and to perform some baseline investigations. At the pre-
assessment visit you will be given information about the procedure.
Please bring a list of all your current medication when you attend your pre-
assessment. If you take Warfarin or Clopidrogel please ensure that your
consultant is aware, as these will have to be stopped before the operation and an
alternative may be prescribed, but this information will be given to you at the pre-
assessment.
You will come into the hospital Same Day Admission Unit (SDAU) on the day of
surgery. On admission, you will be seen by members of the medical team (which
may include the Consultant, Specialist Registrar, and Anaesthetist) and nursing
staff on SDAU. During the admission process, you will be asked to sign a consent
form giving permission for your operation to take place, showing you understand
what is to be done and confirming that you wish to proceed. Make sure that you
are given the opportunity to discuss any concerns and to ask any questions you
may still have before signing the form.

You will be given elasticated stockings provided by the ward to wear which will
help prevent thrombosis (clots) in the veins. You will also receive blood thinning
injection during your stay in hospital to reduce your risk of getting blood clots.
Recent evidence has shown that this risk is further reduced if these injections are
continued for 28 days after your operation. This will be discussed with you by the
surgical team whist you are on the ward. You and or your partner will be taught
how to self administer the injections so that you may continue with the treatment at
home if you wish.
Issued May 2012, reviewed by Urology Nurse Practitioners, Urology Consultants, Ward Sister. Next review date May
2014
Page 2 of 4


Your stay in hospital is usually between 3 to 4 days.



How is the operation performed?

The operation is performed under general anaesthetic, and takes between 30
minutes and 2 hours depending on the size of your stone.

The operation involves removing the stone(s) through a special telescope, which is
passed into your kidney, directly onto the stone, through a small puncture in the
back through skin near to the kidney. Small stones can be removed quite simply
but larger ones need to be broken up before they can be removed.
It may be necessary to puncture the kidney at more than one site if you have many
stones scattered throughout the kidney.
It may also be necessary for a second surgeon to look into the kidney via the
bladder with a long flexible camera. This can be useful if there are multiple stones
in the kidney that require treatment at the same time. Your surgeon will discuss
this with you in more detail before the operation.

Issued May 2012, reviewed by Urology Nurse Practitioners, Urology Consultants, Ward Sister. Next review date May
2014
Page 3 of 4


What to expect after the operation

After your operation you will be taken back to the ward. You will have a drip in your
arm to keep you hydrated, which will be stopped when you are eating and drinking
normally.

You will have a drain in your back, which drains away blood and urine while the
kidney starts healing. This is usually removed 48 hours after the operation. Further
X rays will be requested on the day after the procedure.

During the operation a small tube called a catheter will be inserted into your
bladder, to allow your urine output to be monitored. This is usually removed 24
hours after the operation.

It is normal to experience pain and discomfort after the operation. You will be given
painkillers to relieve this.

You will have a small stent in the ureter (pipe connecting kidney to bladder), which
will need removing after 2 - 4 weeks. See leaflet having a ureteric stent. This is
usually performed under local anaesthetic.

Occasionally some fragments of stone or small blood clots may pass down the
ureter, causing pain in the loin or groin. These fragments are generally passed
quickly, and the pain resolves.

Are there any side effects?

Most procedures have a potential for side-effects. You should be reassured that,
although all these complications are well-recognised, the majority of patients do
not suffer any problems after a urological procedure.

Common (greater than 1 in 10)

Temporary insertion of a bladder catheter and ureteric stent/kidney tube
needing later removal.
Transient blood in the urine.
Transient raised temperature.

Occasional (between 1 in 10 and 1 in 50)

Occasionally more than one puncture site is required.
No guarantee of removal of all the stones and need for further operations.
Recurrence of new stones.
Failure to establish access to the kidneys resulting in the need for further
surgery.

Rare (less than 1 in 50 )

Severe kidney bleeding requiring transfusion, embolisation or at last resort
surgical removal of the kidney.
Damage to lung, spleen, liver requiring surgical intervention.
Kidney damage to infection needing further treatment
Issued May 2012, reviewed by Urology Nurse Practitioners, Urology Consultants, Ward Sister. Next review date May
2014
Page 4 of 4


Over absorption of irrigating fluids into the blood system causing strain on the
heart function.

At Home

You may continue to have blood in your urine for a few days, and this is quite
normal. Aim to drink two litres (about three and half pints or eight cups) of water,
squash or juice each day. Aim to keep the urine permanently colourless to
minimise the risk of further stone formation.

The wound on your back will heal over in a few days. You may notice itching,
tingling or numbness at the site, and the skin may feel hard and lumpy as it heals.
You should keep the wound clean, showering or bathing daily.

If you develop a fever, severe pain on passing urine, inability to pass urine or
worsening bleeding you should contact your GP.

You should be able to return to work as soon as you feel able and comfortable,
which could take up to 2-4 weeks, and you are advised to avoid strenuous exercise
or heavy manual labour during this time to allow the wound to heal.

We recommend that you check with your insurance company before driving.

You can prevent further stone recurrence by implementing changes to your diet
and fluid intake, if you have not already received a written leaflet about this please
ask for one.

You will be seen again by the Urologist in the out patient department,
approximately 2 3 months following your operation.

Points of contact

If you have any other questions, or require more information prior to your
treatment, please contact the Urology nurse practitioners on 01603 289410,
between the hours of 08.00 to 17.30 or leave a message on the answer machine.

If you have any questions, or require more information following your surgery
please contact Edgefield ward on 01603 289962

Issued: August 2005
Review: May 2012
Review date: May2014
Reviewed by: Urology Nurse Practitioners.
Urology Consultants
References; Patientwise- Edited by Dr P Wise, Dr R Pietroni and S Wilkes
British Association of Urology Surgeons website - www.baus.org.uk

This sheet describes a surgical procedure. It has been given to you because it relates to your condition and
may help you understand it better. It does not necessarily describe your problem exactly. If you have any
questions please ask your doctor.