Hard deposits of minerals and salts sometimes form crystallized masses in the urinary tract known as kidney stones. These “stones" are so-named because they develop in the kidneys, although they can cause obstructions in any part of the urinary tract.
If initial treatment efforts involving drinking large quantities of water and alpha blockers or other medications aren’t successful, percutaneous surgery (percutaneous nephrolithotomy) may become an option, especially with larger kidney stones.
Percutaneous surgery is typically done after other kidney stone treatments and therapies fail. The procedure is normally recommended for stones 8/10 of an inch in diameter or larger. Surgery may also be necessary for large staghorn kidney stones. These are crystallized masses that form in one or more branches of a kidney’s collection system.
Prior to surgery, blood and urine tests may be performed to look for urinary tract infections and other issues that may complicate surgery. A CT scan or similar image test is usually done to determine the exact location of the kidney stones.
Percutaneous surgery is performed under general anesthesia. Antibiotics may be given prior to the procedure to reduce the risk of infection. In some situations, X-ray, CT scan, or ultrasound imaging is done under a local anesthetic just prior to starting the procedure to provide visual guidance to the affected kidney.
Another option is to wait to view the affected kidney during the actual procedure while a patient is under general anesthesia. This is done with a tube that’s inserted through the bladder to make a puncture into the affected kidney to remove the stones. X-ray imaging is often used for guidance purposes. More than one puncture may be necessary if the stones are especially large.
The procedure is performed through small incisions made in the back. After placing a sheath into the kidney, an energy probe may be used to break up larger stones. A tube with a camera attached called a nephroscope is used to view and access the affected area and remove the stones. Drainage tubes are sometimes left in place for a short period of time after the procedure. Removed kidney stone fragments may also be analyzed to look for possible signs of an infection.
This type of surgery normally requires a brief hospital stay – usually a few days. After being discharged, patients are typically advised to avoid heavy lifting or strenuous activities for about 2-4 weeks after the procedure. Return to work recommendations following percutaneous surgery will depend on how strenuous your occupation is. Generally, patients are able to safely return to work after about a week. If drainage tubes are left in place, you’ll be advised to look for signs of bleeding or infection.
A urologist may also schedule a follow-up appointment about a month or so after percutaneous surgery. The reason for doing so is to determine if all kidney stones have been effectively removed from your urinary tract. This type of confirmation may involve ultrasound or X-rays. You may also be asked to undergo a urine flow test to make sure your urine is flowing properly again. Additional testing might be done to determine why you developed kidney stones in the first place to reduce the risk of recurrence.