PERCUTANEOUS NEPHROLITHOTOMY - A HIGHLY ADVANCED SURGICAL TREATMENT for large kidney stones
Percutaneous nephrolithotomy (PCNL) is an innovative surgical treatment for patients who have large kidney stones that cannot be treated successfully using ESWL (shock wave therapy) or other treatments. Typically, PCNL is used to remove kidney stones that are larger than 2cm in diameter and cannot be passed through the urinary tract. Percutaneous refers to surgery via a small incision through the skin, rather than an open, more invasive procedure.
PCNL has become a viable and preferred alternative to open surgery for removing kidney stones and should be performed by a highly trained surgeon who has specific experience with this delicate procedure.
In fact, only a small number of urologists nationwide are specially-trained to perform this advanced surgical procedure, including Chesapeake Urology's Julio Davalos, M.D. (pictured).
How PCNL is Performed
Patients present to a hospital or a surgery center for the procedure. The procedure can last from 90 minutes to three hours depending on the complexity of the stone being treated. The procedure is performed under general anesthesia.
Prior to surgery, Dr. Davalos utilizes CT imaging to map out the kidney and to help identify the safest and best entry point into the kidney to ensure a more complete removal of stones.
A small, 1 cm (about 1/2 an inch) incision is made in the patient's back. A small tube is placed into the drainage system of the kidney close to the stone being treated. X-ray imaging is used to help guide the surgeon. A small telescope is then inserted via the tube into the kidney. The stone is then broken up using specialized instruments. The stone pieces are then cleared from the kidney. The goal is to remove 100% of the stone.
Dr. Davalos' Advantage - Tubeless PCNL
Once the PCNL procedure is completed and the kidney stone is removed, some patients will have a nephrostomy tube placed into the kidney and exiting through the skin to drain excess fluid such as blood and urine. Dr. Davalos is one of only a few surgeons in the Mid Atlantic region and the nation who specializes in tubeless PCNL, eliminating the need for the tube to be kept in the patient following the surgery, which offers many benefits.
In tubeless PCNL, Dr. Davalos closes the tract into the kidney created to access the now removed kidney stone using a special plug which Dr. Davalos designed and developed. The plug completely seals the opening into the kidney, removing the need for the external drainage tube, in most cases.
The advantage of the tubeless PCNL procedure include:
- Without a drainage tube, urine leakage at the incision site is eliminated
- Post-operative pain is minimized as no tube is left in the surgical site
- Patients experience a faster recovery and less risk of infection at the surgical site
Following the PCNL or Tubeless PCNL procedure, Dr. Davalos will order a CT scan to ensure that no stone pieces remain. The results are reviewed by your physician and discussed with you prior to discharge.
Advantages of PCNL
Post-procedure stone free rate of greater than 90%
Less post-operative pain as compared to open surgery
Fewer complications as compard to open surgery due to the small incision and minimally invasive access to the kidney
Quicker return to activities of daily living and work compared to open surgery
Comparable return to activities of daily living and work as compared to less invasive options (SWL or ureteroscopy)
Better outcomes for larger and more complex stones as compared to less invasive options (SWL and ureteroscpoy)
Risks of PCNL
When performed by an experienced surgeon, the risk of major complications is less than 1%. As with any surgical procedure, complications can and do occur. Most complications are minor and can be managed while you are at the hospital or surgical center
PCNL- The Chesapeake Urology Difference
While most surgeons rely on an interventional radiologist to locate the kidney stone(s) and then to insert the tube through the patient's skin and into the kidney, Dr. Davlos utilizes a special method to gain renal access with precision, utilizing CT imaging and mapping techniques to ensure the most accurate placement of the tube for the most successful removal of the kidney stone.
Dr. Davlos has performed nearly 1,000 PCNL procedures over his career. This procedure is often a preferred method of getting patients stone free for future management of kidney stone disease and has a high success rate of about 90%.