What is Percutaneous Nephrolithotomy

Percutaneous nephrolithotomy is a procedure to remove kidney stones. Kidney stones are deposits that form inside your kidneys and can cause pain. You may need this procedure if:

• You have large kidney stones. Kidney stones that are bigger than 2 cm (0.78 in) wide may require this procedure.
• Your kidney stones are oddly shaped.
• Other treatments have not been successful in helping the kidney stones to pass.
• You have developed an infection due to the kidney stones.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.
• Whether you use any tobacco products, including cigarettes, chewing tobacco, or e-cigarettes.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding. This may include blood in your urine.
• Allergic reactions to medicines.
• Damage to other structures or organs.
• Kidney damage.
• Holes in the kidney. These often heal on their own.
• Numbness or tingling in the affected area.

Sometimes, not all of the kidney stones are able to be removed with this procedure, so you may need a different procedure to remove them.

What happens before the procedure?

• Follow instructions from your health care provider about eating or drinking restrictions.
• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• Plan to have someone take you home after the procedure.
• If you go home right after the procedure, plan to have someone with you for 24 hours.
• You may have tests, including:
  • Blood tests.
  • Urine tests.
  • Tests to check how your heart is working.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be given antibiotic medicine to help prevent infection.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make you fall asleep (general anesthetic).
  • A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
  • A medicine that is injected into an area of your body to numb everything below the injection site (regional anesthetic).
• A thin tube (catheter) will be put in your bladder to drain urine during and after the procedure.
• Your surgeon will make a small cut (incision) in your lower back.
• A tube will be inserted through the incision into your kidney.
• Each kidney stone will be removed through this tube. Larger stones may need to be broken up with a high-intensity light beam (laser) or other tools.
• If a kidney stone left the kidney, your surgeon will bring it back to the kidney and then remove it through the tube.
• After all of the stones have been removed, a kidney drain tube will be put in. This will help to drain any fluid that builds up while your kidney heals.
• Part of the incision may be closed with stitches (sutures).
• A bandage (dressing) will be placed over the incision area.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored often until the medicines you were given have worn off.
• You may be given medicine for pain.
• You will be encouraged to walk. Walking helps to prevent blood clots.
• You may be taught breathing exercises.
• Do not drive for 24 hours if you received a sedative.

Percutaneous Nephrolithotomy, Care After

Refer to this sheet in the next few weeks. These instructions provide you with information about caring for yourself after your procedure. Your health care provider may also give you more specific instructions. Your treatment has been planned according to current medical practices, but problems sometimes occur. Call your health care provider if you have any problems or questions after your procedure.

What can I expect after the procedure?

After the procedure, it is common to have:

• Soreness or pain.
• Fatigue.
• Some blood in your urine for a few days.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your cut from surgery (incision). Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • More redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Avoid strenuous activities for as long as told by your health care provider.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Do not drive or operate heavy machinery while taking prescription pain medicine.
• Keep all follow-up visits as told by your health care provider. This is important.
• You may have been sent home with a catheter or kidney drain tube. If so, carefully follow your health care provider’s instructions on how to take care of your catheter or kidney drain tube.

Contact a health care provider if:

• You have a fever.
• You have more redness, swelling, or pain around your incision.
• You have more fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.
• You lose your appetite.
• You feel nauseous or you vomit.

Get help right away if:

• You have blood clots in your urine.
• You cannot urinate.
• You have chest pain or trouble breathing.