At the International Kidney Stone Institute, our goal is nothing less than the cure.
Percutaneous nephrolithotomy (PNL) is the best treatment for large stones within the kidney or upper ureter. The procedure involves making a small incision (1 cm) in the back overlying the location of the kidney. A tunnel is then created from the skin into the kidney to allow passage of a telescope. The telescope is used to locate the existing stone and any small stones that may not have been visible by X-ray. The telescope has an inner channel that allows passage of instruments that are used to break up the stone.
The main advantage of PNL is that these same instruments are capable of suctioning out and/or grasping the stone fragments. Not only can a stone be retrieved for analysis, but a patient is usually free of stone following this procedure, and therefore, does not need to worry about passing any stone fragments. If the stone is particularly large or complex, more than one tunnel into the kidney may be necessary to remove all of the existing stone.
At the end of the procedure, a small tube is left to drain the kidney. PNL usually requires a hospital stay of one or two nights. X-rays may be ordered following the procedure to ensure that all of the stone has been removed and to check that the kidney is draining properly. If any stone fragments are remaining, a secondary procedure to remove these fragments may be recommended. The kidney tube is often removed at the end of this secondary procedure. It is normal to have some blood in the urine for a few days following PNL.
In addition to large stones, PNL is favored for treatment of cystine stones and certain types of calcium stones. PNL may be the most effective treatment when multiple and/or bilateral stones are present.
Although PNL is a safe and effective treatment, there are risks to the operation. Some bleeding is expected when the tunnel is created for passage of the telescope into the kidney, but significant bleeding rarely occurs. Bleeding is usually treated by direct pressure over the kidney followed by placement of a tube to drain the kidney. If blood counts drop very low, a blood transfusion may be necessary (1-2% of cases). Although antibiotics are routinely given before PNL, some patients will experience fever following the operation. Fever, which is often a sign of infection, is particularly common in patients with a history of urinary tract infection or in those patients where infection stones are suspected. The infection is treated with intravenous antibiotics and fluids. At the time of surgery, a piece of stone is routinely sent to a lab to look for the presence of infection. The lab can then identify the best antibiotic to treat the infection.
As a member of the International Kidney Stone Institute, James Lingeman, M.D. is recognized as an international authority on the treatment of kidney stone disease. Dr. Lingeman and his colleagues specialize in PNL, performing 300-400 of these procedures every year at Methodist Hospital in Indianapolis, Indiana.