A B C D E F G H I J K L M N O P R S T U V W

PERCUTANEOUS RENAL SURGERY

Why is Percutaneous Renal Surgery performed ?

The treatment of kidney stones depends very much on their size. Very small stones often pass by themselves and do not require operation. Medium sized stones may nowadays also not require operation, as they can be treated by shock wave lithotripsy (a procedure to disintegrate stones from outside the body without an operation). Therefore this operation (percutaneous surgery) is reserved for the larger or awkwardly positioned stones which cannot be treated in any other way: they may have caused pain, infection or bleeding. Nowadays an open operation requiring a large incision to be made is very rare.

Preparations needed for Percutaneous Renal Surgery

The size and position of the stone will be determined by a special x-ray. This x-ray is called an intravenous urogram (IVU). The IVU requires an injection into a vein of an iodine-containing contrast (dye) fluid. Therefore any known allergy to iodine or to previous similar contrast x-rays should be mentioned to the doctor. Urinary infection which is common in patients with stones will be treated before the operation is done. A general anaesthetic and a few nights in hospital will always be necessary. Although the incision is very small and there will be a little discomfort after the procedure, at least 2 weeks for convalescence will be needed. With larger stones, more than one such percutaneous operation may be needed. In addition, lithotripsy may be required to destroy small fragments of stone which may remain. Most of the extra procedures can be arranged as an outpatient or day case, but the whole process of getting rid of the stone can take 6 to 8 weeks. Like all modern techniques, it requires careful planning and the next stage cannot be planned until progress has been assessed, sometimes on a daily basis. Most urologists will always try to avoid an open operation for kidney stones.

What Happens during Percutaneous Renal Surgery

A general anaesthetic is required. First, x-rays or ultrasound (a type of radar using sound waves) are used to find the stone in the kidney. A narrow passage is then made through the skin and into the kidney. This is about 10 to15 cm in length and about 1.5 cm wide. A special telescope called a nephroscope is then passed into this opening. Through the nephroscope long thin metal probes are used to deliver disintegrating shock waves directly to the stone. The resulting fragments are then either sucked or picked out of the kidney. Following the operation a plastic tube drain is positioned in the kidney and emerges from the skin at the site of the skin incision. This tube will usually remain in place for 48 hours.

Possible Complications during Percutaneous Renal Surgery

The principal complications are those of post-operative bleeding and infection. Antibiotics are routinely given before, during, and after the operation. Bleeding in the immediate post-operative period is commonplace, and the tube usually drains blood-stained urine. Blood may be present in the urine at any time for up to 4 weeks after surgery. If this is excessive (bright red in colour), your hospital or doctor should be contacted promptly.

After Percutaneous Renal Surgery

After percutaneous surgery recovery should be quick. It should be possible for you to return to work in 2 to 3 weeks. If lithotripsy has been advised, further x-rays will be taken to assess progress during treatment. Follow-up is usually advised on a 6 monthly or yearly basis. Since you have made one stone, you have a high chance of making further stones. If these are diagnosed early, they can be treated by shock wave lithotripsy alone. In many cases the urologist will arrange special urine and blood tests to find out whether any dietary or drug treatment can be used to reduce the risk of further stones. In many patients, no specific reason for stone formation is discovered. You are likely to be advised to maintain a high fluid intake (3 litres of water per 24 hours). This reduces the likelihood of forming the crystals which are the starting point for kidney stones. Some female patients who have a tendency to urinary infection will also have regular urine tests during their follow-up. If urinary infection persists, long-term antibiotic treatment may be advised.

If Percutaneous Renal Surgery is not performed

Once a kidney stone has caused symptoms, it will continue to give trouble. As the stone increases in size, it tends to block the flow of urine from the kidney and this causes more pain and makes infection difficult to treat. Gradually the combination of blockage and infection causes kidney function to worsen, causing general ill health. Occasionally, with very large stones, an abscess may develop around the kidney. This is a rare but serious complication.