STONE REMOVAL SURGERY – KIDNEY STONES (PCNL)

In what cases is endoscopic kidney stone removal (PCNL) necessary?

Some of the smaller stones located in the kidney pass spontaneously. However, stones can grow to a large size without causing any symptoms or with only mild renal complaints, in which case surgical removal is warranted. We choose this surgical solution for stones larger than 2-3cm or in cases of multiple kidney stones causing a large burden.

If the kidney stone cannot be removed through the urethra due to its location and size, it is removed using an external endoscopic method, i.e., through the skin, via an incision of approximately 1cm.

What kind of preliminary tests are required?

Prior to kidney surgery for stone removal, in addition to a urological examination, a laboratory test, urine culture, and an anesthesiologist examination are required. Before surgery, we almost always request a CT scan to determine the exact size, location and hardness of the stone.

How should you prepare for the procedure?

In certain cases, your doctor may decide that the ureter needs to be treated with medication, or a temporary ureteral stent (double-J catheter) needs to be inserted. If this is necessary, we will inform you separately, but it is not routine. Apart from this, no special preparation is required for the surgery.

How is percutaneous nephrolithotomy (PCNL) performed?

The essence of minimally invasive procedures is to cause as little trauma as possible to the operated organ, in this case the kidney. For this reason, we use ‘mini’ PCNL instruments at our institution, where the working channel is half the size of a traditional PCNL instrument, roughly the thickness of a ballpoint pen. This results in fewer bleeding and infection complications and faster recovery.

The procedure is performed under general anesthesia. During the surgery, a safety catheter is inserted through the urethra into the renal cavity system, which is then filled with contrast medium.

Next, we make a very small, 1cm incision in the skin above the kidney, through which we insert the mini endoscope into the renal cavity system. Here we can visually examine the internal abnormalities of the kidney and remove kidney stones using a laser or stone-removal instruments.

At the end of the surgery, we usually leave a drain in the kidney and ureter and insert a catheter into the bladder.

Advantages of endoscopic stone removal

Endoscopic procedures are less invasive because they do not require opening the body cavity. Patients recover more quickly and experience less pain. The risk of bleeding and complications is also lower, making them a safer option for older patients or those with chronic conditions.

However, in the case of larger stones (2-3cm) or complex, multiple kidney stones, ureteroscopic surgery can be significantly more time-consuming, which increases the risk of complications. Due to the long surgical time, anesthesia may also place a greater burden on the patient. In such cases, percutaneous nephrolithotripsy (PCNL) is recommended.

The advantages of laser stone removal surgery

For stone removal surgery, we have a high-powered holmium laser generator, which allows us to easily pulverize even the hardest stones. The use of the holmium laser speeds up stone removal and makes the intervention more flexible, thus ensuring a higher stone clearance rate.

What should you do after endoscopic kidney stone removal?

After the procedure, patients usually stay in hospital for two days. The urinary catheter and bladder catheter inserted during the operation are removed the day after the operation, followed by the kidney drain the next day. After the procedure, it is important to drink plenty of fluids and take it easy physically. Activity can be gradually increased over the following days, but strenuous activities and heavy lifting should be avoided for approximately 4-8 weeks. Taking a bath and immersion in water are generally contraindicated for 2 weeks. After the surgery, a temporary ureteral stent (double-J catheter) may be left in place, which your doctor will remove at a specified time.

We recommend metabolic testing for patients at high risk of recurrent kidney stones or subsequent stone formation. This consists of a 24-hour urine collection and laboratory testing. The examination may reveal hidden diseases (e.g., hyperparathyroidism, renal ion imbalance), the treatment of which can significantly reduce the risk of recurrent kidney stones. Since every kidney stone is different, the tests must be tailored to the individual.

What are the risks associated with the procedure?

In the first few days after the procedure, urination may be painful due to irritation of the bladder and urethra, and there may be a small amount of blood in the urine, as well as more frequent urination.

The cost of percutaneous nephrolithotomy (PCNL) surgery

You can find our current fees under the prices menu.

WHY CHOOSE DR. ROSE PRIVATE HOSPITAL?

• Highly skilled specialists, modern diagnostic and therapeutic equipment.
• Empathetic, people-centered approach. Our specialists always keep the comfort and safety of our patients in mind.
• Premium-quality inpatient ward. Four operating rooms and 44 patient rooms equipped to meet every need, with 54 beds, are available to our patients. The highest professional standards are combined with an exclusive environment that promotes healing, where you can recover in safety and peace.
• Fast and predictable appointments. We guarantee an appointment for the necessary procedure within 1-2 weeks of the initial specialist consultation.

If you have any urological complaints, please feel free to consult the doctors at Dr. Rose Private Hospital.