Percutaneous Nephrolithotomy

What you should know

Percutaneous (per-ku-TAY-nee-us) nephrolithotomy (nef-roh-li-THOT-oh-me) or "PNL" is surgery to remove kidney stones. Kidney stones are also called renal calculi. Kidney stones are rock-like pieces that can form anywhere in the urinary system. This includes the kidneys, bladder, ureters and urethra (urine tubes). They form most often in the kidneys which are located one on each side in the back of your abdomen. Kidneys clean waste from the blood and make urine. PNL surgery may be done if you have a large stone in your kidney or upper part of the ureter. It may also be done if you have pain, and your stone cannot be treated with a procedure called lithotripsy.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• There are always risks with surgery. You may get an infection, or you may bleed more than usual. If you bleed too much, you may need to have a blood transfusion. You could have trouble breathing. Organs such as the liver, lungs, and spleen could be damaged during surgery. Scars may grow where the stone was located. Caregivers may not be able to remove your kidney stone or may need to do more surgery.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• Kidney stones can stop urine from moving out of your kidney. This can cause kidney damage, kidney failure, and even death. Call your caregiver if you are worried or have questions about your PNL, medicine, or care.

Getting Ready

Before Your Surgery:

• Ask your caregiver if you should stop using aspirin or any other over-the-counter medicine before surgery.
  
  
• Bring a list of your medicines or your medicine bottles when you see your caregiver. Tell your caregiver if you take any herbs, food supplements, or over-the-counter medicines. Tell your caregiver if you have allergies.
  
  
• Tell your caregiver if you know or think you are pregnant.
  
  
• You may need to have an electrocardiogram (EKG), blood and urine tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• Ask caregivers about directions for eating and drinking.

The Day Of Your Surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• Ask your caregiver before taking any medicine on the day of surgery. These medicines include insulin, diabetic pills, blood pressure pills, and heart pills. Bring a list of your medicines or the pill bottles with you to the hospital.
  
  
• Do not wear contact lenses on the day of the procedure. You may wear glasses.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy during surgery.
  
  
• You or a close family member may be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do surgery. It also explains the problems that may happen with your surgery, and your choices. Be sure all your questions have been answered before you sign this form.
  
  
• Ask a family member or friend to drive you home when you leave the hospital. Do not drive yourself home.

Treatment

What Will Happen:

• You will be asked to change into a hospital gown. You may be given medicine in your IV to help you relax or make you drowsy. You will be taken on a cart to the operating room. You will get medicine called anesthesia to prevent pain or keep you completely asleep during surgery.
  
  
• A tiny incision (cut) is made in your back. A nephroscope is put through the incision and into your kidney near the stone. This scope is a long tube with a magnifying glass and a light on the end. Caregivers may use x-rays or ultrasound to help them guide the scope near the kidney stone. The nephroscope and other tools are used to gently remove the stone. A machine such as a lithotriptor or ultrasound may be used to break the stones into smaller pieces. The stone is sent to the lab for tests. The incision is closed with stitches (thread) or steri-strips. You may need to stay in the hospital two to five days after surgery.

After Surgery:

You will be taken to a recovery room. You will be there until you wake up, and then you will be taken back to your room. A bandage will cover your stitches. Do not get out of bed until your caregiver says it is OK.

Waiting Room:

This is a room where your family can wait until you are ready for visitors after your procedure. Your doctor or nurse will find your family in the waiting room to tell them how the procedure went. If your family leaves the hospital, ask them to leave a phone number where they can be reached.

Contact a caregiver if

• You have questions or concerns about your surgery.
  
  
• You have a fever.
  
  
• The problems from your kidney stone get worse.