Indications for nephroscopy
Most often, nephroscopy is performed in patients with an already installed nephrostomy: after PCNL - to make sure that there are no fragments left before removing the nephrostomy; if a tumor of the pelvis is suspected - for examination and biopsy, when retrograde access is not possible; with bleeding from the kidney of unknown cause. A rigid or flexible nephroscope is inserted through the nephrostomy canal, the pelvis and all calyces are examined, if a stone is found, it is immediately removed, and the suspicious tissue is taken for histology. If there is no channel, a puncture is performed under ultrasound, as with nephrostomy.
Indications for percutaneous nephrolithotripsy
- kidney stones more than 2 cm;
- coral-shaped stones filling the pelvis and calyces;
- multiple kidney stones;
- lower calyx stones larger than 1–1.5 cm, which are difficult to pass after ESWL;
- dense stones (more than 1,000 HU), resistant to extracorporeal lithotripsy;
- stones due to kidney anomalies (horseshoe-shaped, double), strictures, after unsuccessful ESWL and ureteroscopy;
- kidney stones with nephrostomy.
How is the operation performed?
The operation is performed under general (less commonly spinal) anesthesia in the prone or dorsal position. First, a thin catheter is placed through the urethra into the ureter, through which the renal pelvis is contrasted and filled - this makes the puncture accurate. Then, under ultrasound and X-ray guidance, the surgeon punctures the desired renal calyx through the skin of the lower back and expands the canal with special dilators to 5–10 mm (with mini-perc – up to 4–5 mm). A nephroscope with a video camera is inserted through the channel.
The stone is destroyed with an ultrasonic, pneumatic or holmium laser lithotripter, the fragments are suctioned and removed with forceps. For coral stones, the surgeon passes through all the calyces sequentially; sometimes, for complete removal, a second stage is performed through the same channel or the operation is supplemented with flexible ureterorenoscopy. Finally, a nephrostomy tube and/or a ureteral stent are placed in the kidney for 1–3 days. Duration: 60–120 minutes.
Mini-perc: reduced access
Mini-perc is a version of PCNL with a 4–5 mm instrument instead of 8–10 mm: less trauma to the kidney parenchyma, less blood loss and pain, and you can often do without a nephrostomy (tubeless). Suitable for 1.5-3cm stones and multiple small stones; For large-volume staghorn stones, standard PCNL remains more effective. The price list of the clinics below shows both options - regular and mini-perc.
Preparation
The main study is MSCT of the kidneys without contrast: it shows the size, shape and density of the stone, the structure of the calyces and allows you to plan the puncture point. A general and biochemical blood test, coagulogram, general analysis and urine culture are required - in case of infection, the operation is postponed until it is cured or the kidney is first drained, since PNL against the background of infection threatens sepsis. ECG, if necessary, consultation with a cardiologist and anesthesiologist. Anticoagulants are discontinued 5–7 days before. Hospitalization the day before, 8 hours on an empty stomach.
Recovery
After the operation, the patient spends 2–4 days in the hospital: the nephrostomy is removed on the 1–3rd day, when the urine becomes light, the stent is removed on an outpatient basis after 1–3 weeks. In the first days, there may be some blood in the urine and pain in the puncture area. Drink plenty of fluids, take antibacterial prophylaxis and limit exercise for 2–3 weeks. Control MSCT or ultrasound after 4–6 weeks confirms complete removal; in case of residual fragments, they are crushed by ESWL or removed with a flexible ureteroscope. The removed stone is sent for composition analysis to select prophylaxis.
PNL in Tashkent: where is it made?
Percutaneous nephrolithotripsy requires a cath lab, nephroscopes, lithotripters, and surgeons with experience in percutaneous surgery. In the clinics below, PNL is performed for single, multiple and staghorn stones, including mini-perc and the second stage for complex stones; there is MSCT and a hospital. Prices are indicated according to the clinic’s price list by type of stone; Anesthesia and bed days are paid separately. Book a consultation with MSCT or ultrasound.
