Percutaneous Nephrolithotomy (PCNL) is one of the most utilized surgical procedures in treating kidney stones because of its efficiency in doing so. However, like all surgical procedures, this method lacks absolute safety, as it poses some risks and complications, especially in cases of advanced kidney stones.
If you’re planning to get a PCNL surgery done or have been recommended to get it, it is essential that you are knowledgeable of the risks and how these risks can be handled. In this blog, we will discuss in detail the common complications associated, factors that aggravate the risks, and the steps that can be taken for smooth recovery.
What is PCNL Surgery?
PCNL (Percutaneous Nephrolithotomy) is a method that is performed when the stone is too large for the patient to either pass or break with other methods like ESWL (shockwave therapy).
How is PCNL Done?
- The surgeon starts off by cutting a small slit (around 1 cm) on the patient’s back.
- After the incision, a small tube is threaded into the kidney through the incision made.
- The nephroscopist then searches for the stone with the nephroscope.
- Ultrasound, laser or pneumatic energy is then used to shatter the stone into smaller pieces and is then taken out.
In cases where the patient’s body requires assistance for healing, a nephrostomy tube may also be inserted.
Possible Risks of PCNL Surgery
Although the success rates for PCNL treatment is quite elevated, it continues to remain a surgical treatment and, just like any other surgery, has its risks. Some of the most frequently reported problems related to PCNL are presented below.
1. Internal Bleeding (Hemorrhage)
Why It Happens:
Considering that there are instruments that need to be inserted into the kidney for the procedure, there is always a possibility of vessels rupturing leading to some internal bleeding.
How Common Is It?
For the majority, there is moderate internal bleeding post-surgery which can be reversed through IV fluids.
Severe bleeding (rare) is a condition that can emerge after a surgery is completed and can frequently require a blood transfusion or other secondary measures in order to stem the bleeding.
Prevention & Management:
Intraoperative bleeding is usually managed with the use of IV fluids or transfusions.
Fluid resuscitation is provided before and post surgery if blood loss is significant.
Other methods such as advanced angiographic embolization (the blocking of vessels which are bleeding) can also be performed.
2. Infection & Fever
Why It Happens:
PCNL does increase the risk of infection due to the fact that kidneys and urinary systems are often harboring bacteria.
How Common Is It?
Fluency throughout the whole body post surgery is common.
Severe infections (like sepsis) aren’t as common, but can be threatening.
Prevention & Management:
The intake of antibiotics before and after the surgery lowers the chances of disease.
Drinking lots of fluids encourages urination, which helps get rid of germs.
As soon as the pain, chills, and high fever emerges, the patient should be reporting it to the professional.
3. Injury to Surrounding Organs
Why It Happens:
There are rare accidental injuries, which can be sustained while doing surgeries, due to the close proximity of kidney to lungs, intestines and liver.
How Common Is It?
Such injuries are uncommon, but if they do occur, more procedures may be needed.
Prevention & Management:
Surgeons have the ability to carry out such procedures with the assistance of imaging guidance i.e Ultrasonography or Fluoroscopy.
Risk is minimized through the careful placement of instruments.
4. Urinary Incontinence (Urinary Fistula)
Why It Happens:
In some cases, patients experience urine leaking into extraneous regions after a stone has been removed from the kidney due to absent ureteral passage to the bladder.
How Common Is It?
Self-resolving in most scenarios, but it’s considered rare.
In more advanced conditions, the patient might need to use a stent or drainage tube.
Prevention & Management:
Appropriate closure techniques can be employed to aid in preventing leakage.
With a nephrostomy tube, short-term placement aids in allowing the kidney to heal.
5. Stone Fragments Left Behind
Why It Happens:
It can also occur that small bits of stones are left after the complete removal of kidney stones, and left limb bits.
Little by little they can expand and lead to new kidney stones forming.
Prevention & Management:
Using X-ray or CT scan post surgery will help to assure that all fragments, big or small, are not left in the body.
Possibly need extra endoscopic procedures or medication may be prescribed authorizing use of RIRS.
6. Fluid Accumulation (Urinary Extravasation)
Why It Happens:
Swelling or pain can occur if urine or surgical fluid enters into other tissues.
How Common Is It?
Mild cases resolve independently given adequate fluids are taken.
Severe cases may necessitate a drainage procedure.
Prevention & Management:
Leakage is prevented by proper sutures.
Imaging follow-up checks helps in confirming adequate drainage of the kidney.
Who is at Higher Risk of PCNL Complications?
When PCNL is done, the procedure is safe, but there is a higher risk of complications for some patients.
- Individuals with disorders of bleeding, especially on anticoagulants.
- People with large / complex stones.
- Patients with current or recurrent renal infections.
- Obesity (higher surgical complexity).
- Multiple previous renal surgeries.
For all of you mentioned above, your urologist will have to take additional steps to mitigate the risks.
How to Reduce the Risks of PCNL Surgery?
- Work with an experienced urology.
- Highly skilled surgeons know how to mitigate complications through perfect techniques.
- Abide by pre-operative protocols.
- Stop blood thinners (if instructed) before the surgery.
- Adequate hydration and dietary guidelines should be followed.
- Take antibiotics as prescribed.
- Infection control after surgery.
- Compression stockings.
- Prevention of blood clots after surgery.
- Follow-up care.
- Assessment of any complications and proper healing will be evaluated by your clinician.
What Makes Dr. Deepanshu Gupta Stand Out For Kidney Stone Surgery?
There are many factors one must put into consideration, however, if you are looking to acquire PCNL or any other treatment related to kidney stones, specialized experience matters a lot. Dr. Deepanshu Gupta is an expert of not only RIRS (Retrograde Intrarenal Surgery), but also endoscopic kidney stone removal PCNL, and is one of the most sought after urologists.
What Makes Dr. Deepanshu Gupta So Special?
- First among his peers in North India for fastest RIRS, holds remarkable success rates
- Fluoroscopy-free RIRS – the most updated method for kidney stone removal that is less invasive
- Has completed over 9500 endoscopic surgeries within the past 12 years
- Completely pain free structure of removal from any part of the body with increased rate of recovery
- Advanced treatment options at economical prices
Final Thoughts: Call Now
PCNL offers an unparalleled solution for patients suffering from large or complex kidney stones. Like every surgical procedure, it is also not free from risk. But, when aided with professional skill during surgery and appropriate management postoperatively, the risks can most certainly be mitigated. Consider meeting with urologist specialist, like Dr. Deepanshu Gupta, so that you can receive up to date and safe PCNL surgery.
We are here and ready to help you. Take action now and schedule an appointment with Dr. Deepanshu Gupta if any expert help is needed to treat kidney stones.