Kidney

Kidney and Ureteral Stones

Percutaneous Nephrolithotomy (PNL)

PNL is a surgery to remove large stones directly from the kidney. The advantage is that even very large stones are removed in a single operation (Fig. 1a and b). PNL is carried out under general anaesthesia.

Fig. 1a: A nephroscope is used to remove stones directly from the kidney.
Fig. 1a: A nephroscope is used to remove stones directly from the kidney.Fig. 1b: Stone fragments are removed in a single procedure with a nephroscope.

Compared to SWL and URS, PNL is more invasive and there is a higher risk of complications. The most common complications are bleeding and fever.

When should I consider PNL?

PNL should be considered when your stone is very large (bigger than 2 centimetres) and has not moved to the ureter. Your doctor may also discuss PNL as a treatment option if:

  • You have more than one stone
  • Your stone is very hard
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Detailed information
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Read more about the PNL procedure, how to prepare, and what to expect after the procedure.

How is PNL performed?

PNL is carried out under general anaesthesia. While you are under anaesthesia, the doctor punctures the kidney with a needle through your skin. The doctor makes the puncture channel large enough to insert the nephroscope. Depending on the size of the stone, it is either removed completely or it is broken into smaller pieces first. Fragmentation of the stone is done with laser, ultrasound, or a pneumatic lithotripter (which works like a little jackhammer). At this point all stone fragments are removed. Sometimes a JJ-stent (Fig. 2) or a percutaneous nephrostomy tube (Fig. 3a and b) is placed to make sure that urine can leave your kidney.

Fig. 2: A JJ-stent is inserted to make sure urine can flow through the urinary tract.
Fig. 2: A JJ-stent is inserted to make sure urine can flow through the urinary tract.

When is PNL not recommended?

PNL is a safe and effective procedure but there are some contraindications because the stone is accessed directly through the skin. If you take medication to prevent blood clotting you should stop taking it before the procedure. However, it is always important to discuss your individual situation with the doctor. In addition, PNL is not recommended if you are pregnant or if your physique makes it difficult to access the kidney.

How do I prepare for the procedure?

Your doctor will advise you in detail about how to prepare for the operation. You must not eat, drink, or smoke for 6-8 hours before the procedure to prepare for general anaesthesia.

How long will it take me to get back to my normal daily activities?

After PNL you will stay in the hospital for some days. In the case that you have a percutaneous nephrostomy tube, you will be discharged when the doctor or nurse can remove it. Your urine might be a little bloody for the first couple of days. Do not plan physical exercise the first two weeks after the procedure.

You need to go back to the hospital right away if you:

  • Develop a fever
  • Feel pain in your kidney or flank
  • Still have blood in your urine a week after the surgery
Fig. 3a: A percutaneous nephrostomy tube is used to drain urine directly from the kidney into the catheter bag.
Fig. 3a: A percutaneous nephrostomy tube is used to drain urine directly from the kidney into the catheter bag.Fig. 3b: A percutaneous nephrostomy tube inside the kidney.

Advantages of PNL

Even very big stones can be removed completely during one single operation

Disadvantages of PNL

  • Requires general anaesthesia
  • Will leave a scar
  • Longer hospital stay
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Asymptomatic stones

Stones that do not cause any symptoms. They are usually found during imaging tests done for another condition.

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Bladder

Organ which collects urine from the kidneys.

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Calculi

Stones.

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Computed tomography (CT)

Imaging technique that makes a series of x-ray images of the body.

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Conservative treatment

Monitoring the progress of the stone disease or treatment with medication to ease the natural passing of stones.

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Contraindication

A symptom or condition that makes a certain treatment option undesirable.

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Decompression

Relieving pressure in the kidneys. A nephrostomy tube is placed directly in the kidney through the skin so that urine can leave the body.

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Endoscope

A tube-like instrument to examine the inside of the body. Can be flexible or rigid.

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Fragments

Pieces of the stone broken during a procedure.

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Intravenous urography

An imaging technique where x-ray contrast agent is injected into the vein, usually in the arm.

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JJ-stent

A tube that is temporarily placed in the ureter to make sure urine can flow from the kidney to the bladder.

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Kidneys

Two bean-shaped organs in the back of the abdomen that filter the blood and produce urine.

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Medical Expulsive Therapy (MET)

Medication that makes the natural passing of stones easier and less painful.

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Metabolic evaluation

Series of blood and urine tests for patients who have a high risk of forming stones.

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Nephrostomy tube

A tube placed directly into the kidney through the skin. This allows the urine to leave the body.

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Non-contrast-enhanced CT

Type of CT scan with low radiation exposure.

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NSAIDs

A group of medicines used to relieve pain. It is often used to relieve renal colic.

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Oxalate

A component found in many kinds of food which may be related to forming kidney or ureteral stones.

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Percutaneous

Through the skin.

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Percutaneous nephrolithotomy (PNL)

Treatment option to remove stones directly from the kidney by placing a tube through the skin.

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PH-value

A measure between 0.0 and 14.0 to describe if a fluid is acidic or alkaline. pH values close to 7.0 are neutral, anything above is alkaline, anything below is acidic.

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Renal colic

Severe pain in flank, loin, groin, or thigh caused by a stone blocking the normal flow of urine.

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Shock-wave lithotripsy (SWL)

Treatment option to break stones into smaller pieces using high energy sound waves. Stone fragments pass with urine after the procedure.

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Ultrasonography

Imaging technique that uses high-frequency sounds to make an image of the inside of the body (ultrasound).

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Ureter

One of the two tubes through which urine flows from the kidneys to the bladder.

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Ureteroscope (rigid or flexible)

An endoscope used for the urinary tract. It is inserted into the urethra and can move through the bladder, up the ureter, and even into the kidney.

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Ureteroscopy (URS)

Treatment option to remove kidney or ureteral stones. A ureteroscope is inserted into the urinary tract via the urethra to pull out the stone.

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Urethra

The tube which carries urine from the bladder and out of the body.

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Uric acid

A chemical that is created when the body breaks down substances called purines.

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Urinary tract

The organ system which produces and transports urine through and out of the body. It includes two kidneys, two ureters, the bladder and the urethra. The urinary tract is similar in men and women, only men have a longer urethra.

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Urolithiasis

Stone disease.

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Urologist

A doctor specialized in health and diseases of the urinary tract and the genitals.

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LUTS

Lower urinary tract symptoms. A term used for the symptoms caused by BPE which can also point to other diseases affecting the urinary tract (see also Urinary tract).

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Active treatment

Procedures to remove a kidney or ureteral stone.

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Adenoma

The enlarged part of the prostate.

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Anaesthesia (general, spinal, or local)

Before a procedure you will get medication to make sure that you don’t feel pain. Under general anaesthesia you are unconscious and unaware of what is happening to you. Under spinal or local anaesthesia you will not feel pain in the part of your body where the procedure is done. Anaesthesia wears off gradually after the procedure.

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Benign enlargement

Cell growth in the body which is not cancerous.

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Cystoscope

A type of endoscope which is used in the urethra (see also Endoscope, Urethra).

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Erectile dysfunction

The inability to get or keep an erection.

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Indwelling catheter

A tube placed in the urethra and bladder to help you urinate.

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Micturition

Urination.

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Minimally invasive procedure

A surgical procedure where there is no need to make an incision in the body. An endoscope is used to reach the part of the body that needs to be treated through the urethra (see also Endoscope).

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Nocturia

Waking up one or more times during the night because of the need to urinate.

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Physical

Having to do with or affecting the body.

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Post void residual urine (PVR)

The amount of urine left in the bladder after urination.

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Prostate

The gland which produces the fluid which carries semen. It is located in the male lower urinary tract, under the bladder and around the urethra.

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PSA (prostate-specific antigen)

A protein produced by the prostate which may increase in men with a benign prostatic enlargement, prostatic inflammation, or prostate cancer.

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Psychological

Having to do with or affecting the mind.

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Resectoscope

A type of endoscope used for minimally invasive treatment of BPE.

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Retrograde ejaculation

A condition when semen can no longer go through the urethra during orgasm but goes into the bladder instead. The semen later leaves the body during urination.

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Urgency

The sudden need to urinate which is difficult to postpone.

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Urinary incontinence

Involuntary loss of urine.

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Urinary retention

When you are unable to urinate. This condition can be chronic.

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Nocturnal polyuria

When the kidneys overproduce urine at night.

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Peripheral oedema

Oedema means swelling. Peripheral oedema refers specifically to swelling of the ankles and legs.

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Primary polydipsia

The sensation that your mouth is dry which leads you to drink too much.

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Obstructive sleep apnoea

Repetitive pauses in breathing during sleep, despite the effort to breathe, commonly paired with snoring.

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Benign Prostate Enlargement (BPE)

An enlargement of the prostate related to hormonal changes with age.

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Overactive Bladder Symptoms

A collection of urinary storage symptoms, including urgency, incontinence, frequency and nocturia.

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Transurethral resection of the prostate (TURP)

TURP is a standard surgery to treat benign prostatic enlargement (BPE). A part of the prostate is removed to improve the symptoms without making an incision in your lower abdomen. This type of surgery is known as minimally invasive treatment.

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Catheter

A hollow flexible tube to insert or drain fluids from the body. In urology, catheters are generally used to drain urine from the bladder.

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Urinary frequency

The need to urinate more often than usual, generally more than 8 times a day.

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