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Percutaneous (percutaneous) nephrolithotripsy is one of the types of surgical treatment of kidney stones. The operation was first performed in 1973. Nephrolithotripsy has been proposed as an alternative to open kidney stone removal. The effectiveness of the percutaneous method is in no way inferior to other modern techniques. Moreover, it has a number of advantages – minimal tissue trauma, quick recovery, the ability to remove stones of any size and structure. What you need to know about the method, how exactly does percutaneous nephrolithotripsy work, and who is the intervention indicated for?
General characteristics of the method
Percutaneous nephrolithotripsy is a minimally invasive surgical intervention aimed at removing stones from the kidney. During the operation, the doctor makes several incisions on the back, through which a special tube is inserted. Then, using a shock wave of ultrasonic / laser / radio wave origin, the stone is crushed into pieces. Fragments of the calculus are removed through the tube, all incisions are sutured, and drainage (nephrostomy) is installed in the kidney itself. At first, it will contribute to the diversion of urine from the body.
Who needs percutaneous nephrolithotripsy?
The method can be applied as a combination therapy. Most often, this is necessary for multiple stone formation in different parts of the body. For example, first, the patient is given an extracorporeal lithotripsy to remove a calculus from the ureter, and then percutaneous nephrolithotripsy to neutralize kidney stones. Percutaneous surgery is indicated for infection of the body, as well as for the removal of large (more than 2 centimeters) and “impacted” stones.
Percutaneous nephrolithotripsy is necessary if there are contraindications to other methods of dealing with kidney stones. Contraindications can be caused by both technical (the patient cannot take the required position) and somatic (pathologies such as renal artery aneurysms) factors. Also, the operation is prescribed for ineffectiveness or the development of complications after the use of other methods.
Contraindications for surgery
The use of the method is contraindicated in hard-to-reach localization of the calculus. The surgeon simply will not be able to act on the stone, regardless of the size and specifics of the endoscopic equipment. Also, the intervention will be ineffective if nephrolithiasis is aggravated by obstruction (narrowing) of the ureter. Additionally, physicians identify relative contraindications – pregnancy / lactation, temporary deterioration in health, exacerbation of chronic pathologies, dermatological diseases, and so on. The doctor must assess the possible risks, determine the appropriateness of the intervention and select an alternative therapeutic method.
Indications and contraindications are always determined by the doctor. Do not self-medicate, so as not to aggravate the health condition.
How to prepare for the intervention?
Each patient must undergo a comprehensive diagnosis of the body in order to confirm or refute the diagnosis. The doctor will receive information about the state of health, individual characteristics and will be able to draw up a therapeutic / preventive course. Diagnostics includes such studies and analyzes:
- general blood/urine analysis;
- coagulogram;
- urine culture;
- hepatic (total protein, bilirubin, albumin) and renal complex (creatinine, urea);
- test for the detection of HIV, hepatitis B and C;
- coprogram;
- fluorography, ultrasound, computed tomography, ECG;
- examination by a specialized specialist and a general practitioner;
- anesthesiologist consultation.
5 days before surgery, the patient should stop taking drugs that affect blood clotting. Before surgery, a thorough bowel preparation is carried out and broad-spectrum antimicrobial drugs are prescribed. They will create additional protection for the body and reduce the risk of infection to a minimum.
Your attending physician will inform you about specific preparation methods, if necessary.
Rehabilitation period
After the intervention, the patient is transferred to the intensive care unit and intensive care unit. There, medical staff will look after him, monitor vital functions and provide the necessary assistance. With a normal reaction of the body, hospitalization does not exceed 6 days. The first few days a person experiences pain and discomfort in the area of intervention. This is a normal reaction of an organism that has experienced stress and tissues that have been damaged. The intensity of pain depends on the individual characteristics of the patient. If you feel discomfort, tell your doctor and ask for pain medication.
Another unpleasant symptom that accompanies the patient for the first few days after surgery is nausea. It is provoked by drugs necessary for anesthesia. Already on the 2-3rd day, the surgeon removes the nephrostomy, which contributed to the diversion of urine. The process is accompanied by slight blood loss, blood impurities can form in the urine within 12-24 hours.
You can function independently, eat and move around the very next day after percutaneous nephrolithotripsy (if there are no complications). As before the intervention, after it, the patient is given broad-spectrum antibacterial drugs. They are necessary to protect a weakened body from infection.
The rehabilitation process takes about a month, but its duration may vary, depending on the condition of the patient and tissues. The surgeon forbids lifting weights weighing more than 5 kilograms, engaging in intense physical activity, in any way affecting the scar. In addition, the doctor gives a list of necessary medications, specific nutritional recommendations and explains how to care for the skin in the area of intervention. During the rehabilitation period, the patient should regularly visit a doctor for a general consultation, testing and health monitoring.
If you feel pain in the lumbar region that cannot be stopped with painkillers, an increase in body temperature, you notice impurities of blood in the urine, consult a doctor immediately.
At the end of the recovery period, the surgeon will issue a referral for final tests. The patient needs to pass the material for the study of blood, urine, undergo X-ray and ultrasound examination. Diagnostics will help evaluate the effectiveness of therapy and determine further actions. In general, the efficiency of percutaneous nephrolithotripsy varies from 90 to 95%.
Possible complications and side effects
Complications and side effects can develop after any surgical intervention. Their intensity and impact on the body depends on the location, size, number of stones, the presence of infection, the competence of the doctor and the specifics of postoperative care. In general, complications can be divided into two large groups: intraoperative and postoperative.
The first group includes bleeding from the kidney (occurs in 4% of patients), perforation of the urinary tract (no more than 0,4% of all complications) and damage to neighboring organs. All of these side effects are preventable. Responsibly approach the choice of a clinic and a surgeon who will be responsible for the quality of your life. An additional benefit will be insurance that can cover the cost of emergency medical care.
Postoperative complications depend not only on the doctor, but also on the patient himself. In 8% of cases, an infectious process develops after the intervention. Infection is possible through the fault of a doctor who performed the intervention in non-sterile conditions or a patient who did not properly treat the wound, thereby exposing himself to the risk of infection. In 4-6% of cases, internal bleeding develops. Its causes may depend on a number of factors – from the wrong actions of the surgeon to excessive physical or emotional overstrain on the part of the patient. To prevent postoperative complications, visit the doctor regularly on time and strictly follow the therapeutic course.