Anyone who's had a kidney stone can attest to how painful the little buggers are. Of course, "little bugger" isn't a medical term—and the word "little" can be misleading.
One of our urologists, Dr. Mark V. Silva, specializes in endourology, which includes the treatment of large kidney stones. In this article, he explains that kidney stones often pass on their own. However, surgery is needed in certain situations, including when the stone is too large to pass.
PCNL is one such procedure for treating large kidney stones. Below, we provide an overview of PCNL based on a video interview with Dr. Silva. (You can also watch the video by scrolling to the end.)
As with all content on our blog, the following is meant to be educational, not medical advice. Always consult your physician regarding your unique healthcare needs.
PCNL stands for percutaneous nephrolithotomy, the surgical treatment for large kidney stones that involves making a small incision in the back.
During the PCNL procedure, your surgeon will make a temporary tract from the back down to the kidney and use a telescope with larger tools to break up and extract the stone.
A kidney stone that's two centimeters or more is considered large.
Urologists can perform PCNL procedures in pediatric patients up to people in their 90s. As long as you have a kidney stone that meets the criteria and you're medically fit for surgery, then PCNL is likely an option.
Your surgeon will make a small incision about the size of a nickel through your back and put a telescope in through the kidney.
Dr. Silva explains, "We use a very sophisticated device that breaks up the stone, washes out the stone, and suctions it out all at once. The incision itself is very small, but getting the access—it does require specialized skills that not every urologist has."
PCNL can't be done in the office. The procedure is performed under general anesthesia, so it requires a trip to the hospital. It is considered an ambulatory surgery. You arrive 45 minutes (or so) before the surgery. You'll then have the surgery, which takes about two to two and a half hours. You'll have a stent that goes from the kidney to the bladder that usually stays in for about one week. Recovery room time is about an hour to an hour and a half.
Dr. Silva tells patients that they're usually back home by dinnertime. (Sometimes, the surgery might require an overnight stay in the hospital.)
PCNL surgery is a more invasive procedure than other options for stone surgery. There is a higher risk of side effects, including the side effects of any surgery, like infection, bleeding, and injury to adjacent organs.
Dr. Silva says, "We minimize the risk by making sure that there's no infection in the urine at the time of surgery. You get antibiotics. And then the biggest risk is always having issues urinating afterwards, and that's alleviated by the fact that you get that tube—that stent—that goes from the kidney to the bladder."
Certain recovery symptoms are normal and to be expected. "You're going to feel a little sore," Dr. Silva explains. "You might feel a little achy, but you can go back to your activities as tolerated."
Dr. Silva tells his patients to give it a few days until they feel like themselves again. He notes that he's had grandparents playing with their grandkids as soon as the next day.
Dr. Silva says Greater Boston Urology in Plymouth is the biggest center along the South Shore for PCNL surgery, largely due to his specialized skill set. Go here to request an appointment.