Kidney stone visualized by fluoroscopy
PCNL or PerCutaneous NephrostoLitotomy is a minimally invasive urologic procedure or a keyhole surgery. Being a keyhole surgery, meaning a small incision is made.
Kidney stones larger than 2 centimetres or those stones not good candidates for ESWL are best managed by this procedure.
The procedure is done under general anesthesia. A small tube called a ureteral catheter is placed through the urinary bladder by using a telescope called a cystoscope. Then the patient is placed on prone position for the main procedure. The kidney is identified through fluoroscopy or C-arm guidance by injecting radiographic dye into the earlier placed ureteral catheter. Once the kidney and puncture site are identified, a small incision is made. The kidney access starts with puncture of a Chiba needle into the identified site under fluoroscopic guidance. Backflow of urine into the needle means that access was successful. A guidewire is then passed into the needle and serial dilation of the tract is made until a special instrument called an Amplatz sheath can be accommodated. This sheath will be the working port where the operating telescope called a nephroscope is inserted. The stone will be broken into small fragments with the use of a device called a lithotriptor. Then the fragments are evacuated. The kidney is checked by fluoroscopy for any residual fragments. Then a tube called a double J stent is inserted through the nephroscope down to the bladder to ensure drainage and prevent blockage of small stone fragments that might have fallen into the ureter. Another tube called a nephrostomy tube is placed on the puncture site after removal of the Amplatz sheath.
The usual total hospital stay is about 4 days. The nephrostomy tube is usually removed 2 days after the procedure. The double J stent is removed after 2-3 months.
Double J stent placed
Puncture of the kidney using Chiba needle and guide wire passed down
PCNL performed by Dr. Latayan
Stone visualisation and fragmentation