PCNL ("keyhole" removal) is used for large stones in the kidney or upper ureter. It can also be used as a “salvage" treatment if other approaches have failed to break or clear the stone. It is a more major procedure than those listed above. It does, however, allow us to clear larger volumes of stone in a single procedure, and to treat stones in awkward positions that would not be easy either to reach with flexible Uretero-Renoscopy (fURS), or to target with Extracorporeal shockwaves lithotripsy (ESWL).
The procedure entails creating a small tract into the kidney from the body side wall, utilizing ultrasound or X-ray guidance to target most of the stone burden in the kidney. In our urology department, we have multidisciplinary team approach to create the most efficient access to remove stones, so we enroll our interventional radiologist colleagues to assist in establishing the access while ensuring the integrity of nearby organs and that blood vessels are not jeopardized.
After establishing the tract into the kidney, Multiple energy sources can be used to fragment the stones such as ultrasonic waves, LASER probes, electrohydraulic or pneumatic (Jack-hammering).
Based on stone size, position and density, our Urologist will decide which energy source and approach to the stone can be used.
Advantages:
- Large stones can be removed in a minimally invasive manner.
- Can treat larger stone burdens and harder stone that cannot be treated with other modalities.
- Shorter hospital stays and early recovery compared to old open surgery.
Disadvantages:
- Considered more invasive compared to other kidney stones treatment modalities as flexible ureteroscopies.
- Greater risk of bleeding and injury of organs near the kidney
- Risk of procedure failure to target stones in certain locations.
For more information, please visit:
https://www.baus.org.uk/_userfiles/pages/files/Patients/Leaflets/PCNL.pdf
