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When do you need a Nephrolithotomy?
Nephrolithotomy is recommended for patients if they experience the following symptoms:
- The kidney stone has a diameter of around 4 to 5 inches or more.
- If they are dense.
- There is a presence of staghorn that blocks most parts of the kidney.
- The patient has tried different treatments but they didn't work.
About 85 to 90% of the time, nephrolithotomy can fully remove the stones. If the patient has a severe heart or lung problem, or is prone to uncontrolled bleeding, then the he/she is not a good fit for the procedure.
How is nephrolithotomy procedure carried out?
The surgeon will check for any underlying infections by testing a sample of urine and blood of the patient before the surgery. ACT scan, ultrasound, or X-ray will be performed to determine the specific location of the stones. The procedure normally takes an hour or two to complete. The patient has to lie down on a surgical table, facing down. A dye or carbon dioxide is injected into the bladder to use a scope and view the branches of the kidney.
A small cut is then made midway down your back where the stones are present. A fiber-optic camera is used to peer in. Laser, ultrasonic or mechanical device is used to break the stones, then the stones are crushed and removed. This process is called nephrolithotripsy.
The patient is provided a tiny stent that helps with draining urine, by keeping the conduit between the kidney and the bladder open. A tube may also emerge from the incision to drain fluid from the kidney into a bag attached to the outside of the body. After 1-2 weeks, the doctor will remove it.
What are the possible complications that arise after a nephrolithotomy?
After a nephrolithotomy procedure is administered, patients may experience the following complications:
- Bleeding – Though there is not much blood loss, a week before the surgery the patient has to avoid any medications that makes the blood harder to clot.
- Infection - Fever, discharge from the back incision, pain when peeing, or frequent trips to the bathroom are all signs.
- Organ injury – The procedure has a small chance of causing harm to organs near the kidney, such as the colon, blood arteries, spleen, and liver. It's possible that the ureter, which transports urine from the kidney to the bladder, will be perforated. This could result in scarring or the need for surgery to restore the damage.
What can you expect during post-surgical care for nephrolithotomy?
Post-surgery, the patient is required to stay in the hospital for a few days. The tube may be left in place for certain patients, and the surgeon will provide instructions on how to use the tube. Before the patient is discharged, the catheter will be removed.
After four to six weeks, the patient is required to fix an appointment with your doctor. Ultrasound or X-rays are used at that time to check for any remaining stones and to ensure that urine is passing through the kidney.
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