Patient education: Percutaneous nephrolithotomy (The Basics)

What is percutaneous nephrolithotomy? — 

Percutaneous nephrolithotomy, or "PNL," is a procedure to remove 1 or more kidney stones. These are just what they sound like: small stones that form inside

the kidneys (figure 1). They form when salts and minerals that are normally in urine build up and harden.

During PNL, a doctor makes a very small cut, or "incision," in the skin. They pass tiny tools through the incision and into the kidney. Then, they remove the stone.

How do I prepare for PNL? — 

The doctor or nurse will tell you if you need to do anything special to prepare.

Before the procedure, your doctor will do an exam. They might send you to get tests, such as:

●A urine test – This is to check if you have a urinary tract infection, or "UTI." If you have any symptoms of an infection, they will also do a more detailed urine test to check for bacteria. If you have signs of an infection and you cannot urinate, you might need to have another procedure before PNL.

●Blood tests

●A CT scan, intravenous pyelogram, or other imaging tests – These create pictures of the inside of the body.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before the procedure – You might need to "fast" before surgery. This means not eating or drinking anything for a period of time. Or you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during PNL? — 

When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get general anesthesia medicines. This is to make sure you do not feel pain during the procedure. General anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. You might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make a small incision in your skin, likely on your back or side.

●They will use imaging tests, such as an ultrasound or special X-rays, to create pictures of your kidney. They will place a small tube called a "sheath" into the incision. They will use the imaging tests to place the sheath in the correct place in your kidney.

●They will put a thin tube with a tiny camera on the end into the sheath. They will use the camera to look for the kidney stone. Once they find it, they will remove it. If the stone is large, they might break it into smaller pieces first. Sometimes, they use shock waves or lasers to break it.

●They might put a small tube into the kidney, called a "nephrostomy." They might also put a small tube in your ureter, called a "ureteral stent." (Ureters connect the kidneys to the bladder.) These tubes help drain urine into your bladder.

●They will close your incision and cover it with clean bandages.

●The procedure usually takes 1 to 3 hours.

What happens after PNL? — 

You will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people spend 1 to 3 days in the hospital after PNL.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●If the doctor put in a bladder catheter or nephrostomy tube, these are usually removed before you leave the hospital. In some cases, they might send you home with these still in. If they do, they will tell you how to care for these at home.

●You might get imaging tests, such as X-rays, to check for any problems from the procedure.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of PNL? — 

Your doctor will talk to you about all the possible risks, and answer your questions. Possible risks include:

●Bleeding

●Infection

●Pain

●Kidney injury

●Fluid collecting in the belly

●High blood pressure

●Problems with the nephrostomy tube, if you got one

Some people need to have another procedure to remove:

●Parts of the stone that were not removed during the first procedure

●New kidney stones

What else should I know? — 

Before you go home from the hospital, make sure you know what problems to look out for and when to call the doctor. Make sure you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Percutaneous nephrolithotomy – Discharge instructions (The Basics)
Patient education: Kidney stones in adults (The Basics)
Patient education: Kidney stones in children (The Basics)
Patient education: Urinalysis (The Basics)
Patient education: Urinary tract infections in adults (The Basics)
Patient education: Urinary tract infections in children (The Basics)
Patient education: Intravenous pyelogram (The Basics)
Patient education: Lithotripsy for kidney stones (The Basics)
Patient education: Percutaneous nephrostomy (The Basics)
Patient education: How to care for a nephrostomy tube (The Basics)
Patient education: Ureteral stent placement (The Basics)

Patient education: Kidney stones in adults (Beyond the Basics)
Patient education: Kidney stones in children (Beyond the Basics)
Patient education: Urinary tract infections in adults (Beyond the Basics)
Patient education: Urinary tract infections in children (Beyond the Basics)