Percutaneous urinary procedures

Definition

Percutaneous (through the skin) urinary procedures help drain urine from your bladder and get rid of kidney stones.

Alternative Names

Percutaneous nephrostomy; Percutaneous nephrostolithotomy; PCNL; Nephrolithotomy; Kidney stent placement; Uteric stent placement

Description

A percutaneous nephrostomy is the placement of a small, flexible rubber catheter (tube) through your skin into your kidney to drain your urine.

Percutaneous nephrostolithotomy (or nephrolithotomy) is the passing of a special medical instrument through your skin into your kidney. This is done to get rid of kidney stones.

Most stones will pass out of the body on their own through urine. But when they do not, your doctor may recommend these procedures.

You will lie on your stomach on a table. You will be given a shot of Lidocaine or Xylocaine (the same medicines your dentist uses to numb your mouth). Your doctor or nurse may give you drugs to help you relax and reduce your pain.

If you have nephrostomy only:

• First your doctor will insert a needle into your skin. Then the nephrostomy catheter will be passed through the needle and into your kidney.
• You may feel some pressure and discomfort when the catheter is inserted.
• A special type of x-ray will be used to make sure the catheter is in the right place.

If you have percutaneous nephrostolithotomy (or nephrolithotomy):

• The doctor makes a small incision (cut) on your back and passes a needle through the skin to your kidney.
• Special instruments are then passed through the needle. Your doctor will use these to take out the stone or break it into pieces.
• After the procedure, a tube is placed in the kidney (nephrostomy tube), and another tube, called a stent, is placed in the ureter to drain urine from your kidney. This allows your kidney to heal.

The place where the nephrostomy catheter was inserted will be covered with a dressing. The catheter itself will be connected to a drainage bag.

Why the Procedure Is Performed

Reasons to have a percutaneous nephrostomy or nephrostolithotomy are:

• Your flow of urine is blocked.
• You are having a lot of pain even after being treated for a kidney stone.
• X-rays show the kidney stone is too large to pass by itself.
• Urine is leaking inside your body.
• The kidney stone is causing urinary tract infections.
• The kidney stone is damaging your kidney.

Risks

Percutaneous nephrostomy and nephrostolithotomy are generally safe. Ask your doctor about these possible complications.

• Pieces of stone are left in your body. You may need more treatments.
• There is bleeding around your kidney.
• Your kidney(s) may not work as well, or they may stop working.
• Pieces of the stone may block urine flow from your kidney. This may cause very bad pain or damage to the kidney.
• Kidney infection may occur.

Before the Procedure

Always tell your doctor or nurse:

• If you are or could be pregnant.
• What drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
• If you have been drinking a lot of alcohol.
• You are allergic to contrast dye used during x-rays.

On the day of the surgery:

• You will usually be asked not to drink or eat anything for at least 6 hours before the procedure.
• Take your drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive at the hospital. Bring all of your medicines with you.

After the Procedure

You will be taken to the recovery room. You may be able to eat soon if you do not have an upset stomach.

You may be able to go home within 24 hours. If there are problems, your doctor may keep you in the hospital longer.

The doctor will take out the tubes if x-rays show that the kidney stones are gone and your kidney has healed. If stones are still there, you may have the same procedure again soon.

Outlook (Prognosis)

Percutaneous nephrostolithotomy or nephrolithotomy will almost always help ease the symptoms of kidney stones. Often, your doctor is able to get rid of your kidney stones completely. But sometimes you will need to have other procedures to get rid of the stones.

Most people who are treated for kidney stones need to make lifestyle changes so that their bodies do not make new kidney stones. These changes include avoiding certain foods and not taking certain vitamins. Some people also have to take medicines to keep new stones from forming.

References

Lingeman JE, Matlaga BR, Evan AP. Surgical management of upper urinary tract calculi. In: Wein AJ, ed. Campbell-Walsh Urology. 9th ed. Philadelphia, PA: Saunders; 2007:chap 44.

Wen CC, Nakada SY. Treatment selection and outcomes: renal calculi. Urol Clin North Am. 2007;34(3):409-419.