Percutaneous removal of kidney stones
What is percutaneous removal of kidney stones?
This is the breaking up and removal of kidney stones with a telescope placed into the kidney through a small puncture in the back. This usually includes cystoscopy and X-ray screening.
What are the alternatives?
The main alternatives include external shock wave treatment, open surgical removal of stones and observation of stones. Alternative treatments can be discussed in detail with your urologist or specialist nurse; this supersedes any advice you may have been given by your GP.
Before the procedure
If you are taking Aspirin on a regular basis, you must stop 7 days before your admission, even if you are only taking a small dose. Treatment can be re-started safely about 3 days after you get home.
You may be admitted on the same day as your surgery and may also be sent a pre-clerking appointment to assess your general fitness and to perform some baseline investigations. After admission, you will be seen by one of the medical team comprising the Consultant, Specialist Registrar, House Officer and your named nurse. An X-ray may be taken before surgery to confirm the position of your stone(s).
You will be asked not to eat or drink for 6 hours before surgery. You may be given a pre-medication by the anaesthetist that will make you pleasantly sleepy and dry-mouthed.
The procedure – what will happen?
Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure.
The operation is usually carried out in a single stage. First, a small tube is inserted up the ureter into the kidney by means of a ‘telescope’ passed into the bladder. You are then turned on to your face and using X-ray guidance a puncture is made into the kidney. Finally, a telescope is passed into the kidney and the stone(s) removed or disintegrated. A catheter is usually left in the bladder at the end of the procedure together with a drainage tube in the kidney (a nephrostomy tube). It may be necessary to puncture the kidney at more than one site if you have many stones scattered throughout the kidney.
Immediately after the procedure
On the day after surgery, a further X-ray is normally performed to assess stone clearance. Occasionally, it may be necessary to perform an X-ray down the kidney drainage tube using contrast medium. If the X-ray is satisfactory, the tube in your kidney and the bladder catheter will be removed. There is often some leakage from the kidney tube site for 24-48 hours and you will be only discharged once this leakage has resolved.
The average hospital stay is 3 days.
Are there any side-effects and risks?
Most operations have a potential for side-effects and these are outlined below.
Common (more than 1 in 100)
• Temporary insertion of a bladder catheter and ureteric stent/kidney tube needing later removal
• Transient blood in the urine
• Transient raised temperature
Occasional (more than 1 in 500)
• Occasionally more than one puncture site is require
• No guarantee of removal of all stones and need for further operations
• Recurrence of new stones
Rare (less than 1 in 100)
• Severe kidney bleeding requiring transfusion, embolisation (cutting off the blood supply to the kidney) or at last resort surgical removal of kidney
• Damage to lung, bowel, spleen, liver requiring surgical intervention
• Kidney damage or infection needing further treatment
• Over-absorption of irrigating fluids into blood system causing strain on heart function
What should I expect when I get home?
When you get home, you should drink plenty of water to flush your system through an minimise any bleeding. You should aim to keep your urine permanently colourless to minimise the risk of further stone formation.
It may take at least 2 weeks to recover fully from the operation. You should not expect to return to work within 10 days, especially if your job is physically strenuous.
What else should I look out for?
If you develop a fever, severe pain on passing urine, inability to pass urine or worsening bleeding, you should contact your GP immediately. Small stone fragments may also pass down the ureter from the kidney, resulting in renal colic (severe loin pain); in this event, you should contact your GP immediately.
Are there any specific points?
You can prevent further stone recurrence by increasing your fluid intake and eating a balanced diet. If you have not already received a written leaflet about this, contact your named nurse. If you need further information, please telephone the Specialist Nurse.
