Doctors for Percutaneous Nephrolithotomy in Bangalore

Percutaneous nephrolithotomy (PCNL) is a method for eliminating stones from the kidneys, and other organs in the urinary tract such as the ureters, bladder, or urethra. It is used to remove large or complex kidney stones that are not treatable with other non-invasive or minimally invasive treatments.

There are various types of PCNL procedures that may be performed, depending on the size, location, and complexity of the kidney stone:

• Standard PCNL: Standard PCNL is a minimally invasive surgical procedure used to remove large kidney stones that cannot be treated with non-invasive methods. The procedure entails making a small incision in the back of the patient and forming a tract from the skin to the kidney. A specialized instrument called a nephroscope is then inserted through the tract to visualize and remove the stone(s).
• Mini-PCNL: Mini-PCNL (percutaneous nephrolithotomy) is a minimally invasive surgical procedure that is similar to standard PCNL, but uses smaller instruments and incisions. Mini-PCNL is typically performed for the removal of smaller kidney stones (up to 2 centimeters in diameter) that cannot be treated with non-invasive methods such as shock wave lithotripsy or ureteroscopy.
• Ultra-mini PCNL (UMP): This is a minimally invasive surgical procedure used for the treatment of kidney stones that are less than 1.5 centimeters in diameter. UMP is similar to standard PCNL and mini-PCNL but uses even smaller instruments and incisions.
• Micro-PCNL: This is the latest form of PCNL, where a micro nephroscope is used. It is mainly employed in treating smaller stones and the micro nephroscope provides the lesser risk of tissue trauma or bleeding. Micro-PCNL is conducted with even smaller instruments and incision sizes than other forms of PCNL, resulting in a faster recovery.

Some diagnostic tests and evaluations are essential for ensuring that PCNL surgery is safe and effective for the patient. The urologist and medical team will use the information gathered from these tests to determine the most appropriate surgical technique, anesthesia, and post-operative care for the patient. Some of these tests include:

• Medical history: The information gathered in a medical history helps healthcare providers to better understand a patient's health status, identify potential risk factors, and develop an appropriate plan of care.
• Physical exam: A thorough physical examination is carried out on the patient in order to evaluate their overall health as well as the function of their kidneys. Before beginning the operation, the urologist will conduct an assessment of the patient's vital signs, which will include measuring the patient's blood pressure, heart rate, and any other essential signs that are necessary to determine the patient’s stability.
• Imaging studies: Medical imaging techniques like CT scans, X-rays, or ultrasounds are employed to detect and determine the quantity, location, and dimensions of kidney stones. Such information is crucial in selecting the optimal surgical method and making necessary arrangements for the procedure.
• Complete Blood Count (CBC): A complete blood count (CBC) is a test that enumerates the number of white blood cells, red blood cells, and platelets present in the patient's blood. Any irregularities in these counts may suggest the presence of an infection or a bleeding condition, which could have implications for the surgery or post-operative recovery.
• Blood Chemistry Tests: In a blood chemistry test, various substances such as electrolytes, glucose, and creatinine are quantified in the blood. Anomalies in these levels could signify the presence of liver or kidney issues, which may impact the surgery or recuperation process.
• Coagulation Tests: Tests for coagulation assess the clotting potential of the blood, which is crucial in averting unnecessary bleeding during the operation. Deviations in these measurements may imply a propensity for bleeding disorders or a likelihood of unwarranted bleeding during the procedure.
• Urinalysis: During a urinalysis, the patient's urine is analyzed to determine whether or not it contains blood, protein, or any other substances that could point to kidney disease or an infection.
• Blood Grouping and Crossmatching: Blood grouping and crossmatching tests are done to determine the patient's blood type and to identify any antibodies that may cause a reaction during the procedure.
• Electrocardiogram (ECG): An ECG is performed to assess the patient's heart function and detect any underlying heart conditions that could increase the risk of complications during the procedure.
• Anesthesiology evaluation: An anesthesiologist evaluates the patient's suitability for general anesthesia and determines the best type of anesthesia to use based on the patient's medical history, physical exam, and other test results.
• Renal Function Tests: Renal function tests assess the kidneys’ ability to filter waste products from the blood and are used to detect any underlying kidney problems or dysfunction.
• Serum Iron Studies: Serum iron studies measure the amount of iron in the blood and are used to detect anemia in the patient, which can impact the surgical process or recovery.
• Thyroid Tests: Thyroid tests measure the levels of hormones produced by the thyroid gland and are used to detect any underlying thyroid condition which could impact the surgery or recovery process.

The operation is normally conducted under general anesthesia and consists of the following steps:

• Preparation: The patient is positioned on their stomach, and the surgeon uses imaging techniques such as X-rays or ultrasound to locate the kidney stone.
• Incision: The surgeon creates a passage to the kidney by making a minor incision in the patient's back.
• Guidewire placement: A thin, flexible guidewire is inserted through the incision and into the kidney, which allows the surgeon to guide the instruments to the location of the stone.
• Dilation: A series of dilators are passed over the guidewire to widen the tract and create a tunnel to the kidney.
• Nephroscope insertion: A nephroscope, a specialized instrument equipped with a camera and a light source, is inserted through the incision and into the kidney.
• Stone removal: The surgeon uses various instruments, such as forceps, lasers, or ultrasound probes, to locate and break up the kidney stone. The stone is then eliminated through a nephroscope or fragmented into smaller pieces for removal.
• Drain placement: A small tube may be placed in the incision to help drain any remaining fluid or blood.
• Closure of the incision: Once all the fragments have been eliminated, the incision is shut and secured using sutures or staples. In certain circumstances, a drain may be positioned at the site of the incision to facilitate the removal of any fluids or blood that may have accumulated.
• Recovery: After the procedure, the patient is typically monitored in the hospital for a few days and may experience some pain and discomfort, as well as blood in their urine. The time it takes to recuperate depends on the size and location of the stone.

PCNL (Percutaneous Nephrolithotomy) surgery is one of the most effective treatments for kidney stones and is performed in Bangalore by experienced urologists. The main benefits of PCNL surgery are:

• Highly Effective: PCNL surgery is a highly effective procedure with a success rate of up to 98%, making it a dependable choice for patients seeking a prompt and efficient resolution for their kidney stones.
• Minimally Invasive: PCNL surgery only involves making a small incision and inserting a tube into the kidney, which lowers the risk of complications and results in a quicker recovery time.
• Painless: PCNL surgery is designed to encourage minimal discomfort during and after the procedure, with painkillers being prescribed if needed.
• Quick Recovery Time: Since it is minimally invasive, the recovery time for PCNL surgery is shorter than other types of surgery, with most patients able to go back to their regular routines just a few days after the procedure.
• Cost-Effective: The cost of PCNL surgery is comparatively lower than other kinds of treatments for kidney stones, making it a great choice for those looking for an effective treatment that fits their budget.
• Minimal Risk of Complications: Thanks to its minimally invasive nature, PCNL surgery has little to no risk of complications, allowing patients to receive the treatment with peace of mind.

These side effects may occur after the PCNL procedure:

• Pain: The PCNL surgery is linked to the most frequent side effect, which is pain. This pain is typically alleviated by medications and other methods, and it generally occurs in the regions where the kidney was accessed or where minor incisions were created.
• Bleeding: Another potential complication related to PCNL surgery is the risk of bleeding. Although it usually stops on its own, if bleeding persists, doctors may need to carry out additional procedures to stop it.
• Infection: Bleeding is another potential consequence of PCNL surgery that may happen during or after the treatment. While it often stops on its own, in cases where bleeding persists, doctors may need to perform additional procedures to control it.
• Flank pain: PCNL surgery can also cause flank pain as a common side effect. However, this pain is usually mild and easily treated with medications and other therapies.
• Urinary problems: In uncommon instances, patients may experience urinary alterations following PCNL surgery. These alterations may manifest as a decreased urine flow, a burning sensation during urination, or urinary tract infections.
• Allergic reactions: Individuals may develop an allergic response to the medications administered during PCNL surgery. These reactions can manifest as hives, swelling of the lips and tongue, breathing difficulties, skin rashes, headaches, dizziness, or other severe symptoms.
• Nausea and Vomiting: Several patients who have PCNL surgery also experience postoperative nausea and vomiting. Patients are advised to stay hydrated by drinking fluids and refrain from eating until the nausea subsides.
• Kidney Damage: Although uncommon, PCNL surgery can cause damage to the kidney in some cases. This may present as alterations in urine or the identification of a new area of tenderness over the kidney following the procedure.

Recovering from a PCNL procedure can take several weeks, but most patients can resume their regular activities within a few weeks of the surgery. Throughout your time of healing, keep these things in mind.

• Rest: After PCNL surgery, rest is a vital element of the recovery process. It is recommended to avoid any strenuous activities for a few weeks after the procedure, and taking daytime naps, if possible, can also be helpful in the recovery process.
• Diet: Proper nutrition and hydration are crucial for a smooth recovery after PCNL surgery. Consuming a balanced diet with plenty of fresh produce and lean proteins can support the healing process. Dehydration may occur by consuming alcohol or beverages with caffeine, therefore it's best to abstain from them. Throughout the recovery period, it is crucial to drink enough of fluids, especially water, to maintain proper hydration.
• Medication: To manage pain and prevent infection after a PCNL surgery, it is crucial to follow your doctor's prescribed medication regimen. This includes taking the medication in the specified amount and frequency. It is beneficial to keep a schedule of when to take the medication and use reminders, such as alarms, to ensure timely and proper administration.
• Exercise: Gradually introducing light exercises like walking or stretching can aid in promoting healing and preventing complications after a few days of rest following PCNL surgery. Nevertheless, before beginning an exercise program, it is recommended that you speak with your doctor for advice. Gentle activities such as swimming can also be beneficial in strengthening muscles and restoring normal body function.
• Follow-up appointments: To track your recovery following PCNL surgery, you must attend all follow-up appointments. During these appointments, your doctor may remove drainage tubes or change bandages. Keeping track of these appointments and preparing any questions beforehand can make them more productive.
• Incision site care: Proper wound care is crucial for preventing infections and promoting healing after PCNL surgery. It is necessary to keep the surgical sites clean and dry and follow the doctor's instructions for caring for them. Regularly changing the bandages and applying topical ointment as needed are also important for the incisions to heal properly.