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Percutaneous nephrolithotomy (PCNL) is a minimally-invasive procedure to remove stones from the kidney by a small puncture wound (up to about 1 cm) through the skin. It is most suitable to remove stones of more than 2 cm in size and which are present near the pelvic region.
Surgery was the only method to remove stones too large to pass until French surgeon and urologist Jean Civiale in 1832 invented a surgical instrument (the lithotrite) to crush stones inside the urinary bladder without having to open the abdomen. To remove a calculus, Civiale inserted his instrument through the urethra and bored holes in the stone.
Laser lithotripsy (LL) has been evaluated against Extracorporeal Shock Wave lithotripsy (ESWL), finding both to be safe and effective. [3] [4] ESWL may be safer for small stones (<10 mm), but less effective for 10–20 mm stones. [3]
Infection stones can grow rapidly, forming large calyceal staghorn (antler-shaped) calculi requiring invasive surgery such as percutaneous nephrolithotomy for definitive treatment. [75] Struvite stones (triple-phosphate/magnesium ammonium phosphate) have a 'coffin lid' morphology by microscopy. [74]
Postoperative wounds are those wounds acquired during surgical procedures. Postoperative wound healing occurs after surgery and normally follows distinct bodily reactions: the inflammatory response, the proliferation of cells and tissues that initiate healing, and the final remodeling.
A nephrostomy or percutaneous nephrostomy is an artificial opening created between the kidney and the skin which allows for the urinary diversion directly from the upper part of the urinary system (renal pelvis). [2] It is an interventional radiology/surgical procedure in which the renal pelvis is punctured whilst using imaging as guidance.
Some of the passed fragments of a 1-cm calcium oxalate stone that was smashed using lithotripsy. The most common use of extracorporeal shockwave therapy (ESWT) is for lithotripsy to treat kidney stones [3] (urinary calculosis) and biliary calculi (stones in the gallbladder or in the liver) using an acoustic pulse.
The surgery is performed with the patient under general anesthesia. A kidney can be removed through an open incision or by laparoscopic surgery. For the open procedure, the surgeon makes an incision in the side of the abdomen to reach the kidney. Depending on circumstances, the incision can also be made midline.