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Dr. Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3563
Experience:  MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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I have had two kidney stone surgeries in the past on my left

Resolved Question:

I have had two kidney stone surgeries in the past on my left kidney. Both times, the doctors went through the ureter and blasted the stones. Small fragments were left in the lower pole, however.

Now, I have a new doctor (the old one moved away). He prescribed renal sonograms for the past 3 years and there was apparently no change (just a 6mm stone in the left lower pole). I recently had a CT scan (stomach issues) and they found that I have a 6x9mm stone in the lower pole. When the doctor measured it himself from the films, he said it's close to 10mm and taking up most of the room in the lower lobe.

He also found a 7mm stone in the mid-section of the collecting system of this same left kidney.

My question:
the doctor wants to do a left PCNL. Is this the best choice? Is it dangerous or more dangerous than the laser surgery I have already had? What are the risks? What is the post-surgical recovery like?

Thank you!
Submitted: 1 year ago.
Category: Urology
Expert:  Dr. Tharun replied 1 year ago.
HI

10 mm means a 1 cm and PCNL would be an overkill for it especially when it is a silent stone without symptoms.

PCNL is straight forward in cases of stones bigger than 2 cm, but anything below that other options should be considered.

The two options we have is ESWL and Laser lithotripsy(RIRS).

Although ESWL is not always successful in cases of lower pole stones, because the fragments may never drain off from the kidney due to the dependent position.But it is least invasive with minimal complications.
Next option is RIRS - going with a ureteroscope and fragmenting it with a laser.This is the best option in the hands of an experienced doctor.It is time consuming as well as an expensive option, but complication profile is minimal.

PCNL is key hole surgery with risk of bleeding and some loss of kidney mass.Rest is advised for 2 weeks after the surgery.Where as in previous two options no rest is recommended.

Newer techniques like Mini PERC and Micro -PERC are still in early phase of development and everyone may not be well versed with it.

I hope this answers your question.

Regards

Dr.Tharun
Customer: replied 1 year ago.


The doctor mentioned that the surgery is only 90 minutes. If this is the mini PCNL, is that safe? What are the risks? What is the recovery like?


 


For the past two surgeries, they weren't able to get the stones out of the lower ple.

Expert:  Dr. Tharun replied 1 year ago.
Mini PCNL is same as normal PCNL except smaller equipments are used for the procedure.

It was basically designed to do PCNL in children, which was later adapted for adults.

PCNL has a complication rate of less than 5 %.In experienced hands it may be much lesser.

Mini -PCNL the risks are similar but slightly less and rest period is again around 2 weeks.

I guess past surgeries were not done using flexible Ureteroscope.These scopes are specifically designed to go into lower poles and break stones.

Dr.Tharun
Customer: replied 1 year ago.


Would I have tubes in me for two weeks? Can I go to work if I have a desk job?


 


What are the complications for the 5% of people that have them?


 


How long is the hospital stay?

Expert:  Dr. Tharun replied 1 year ago.
HI

Most PCNL would have a tube within the kidney to the bladder(stent) and a tube coming outside from the back(Nephrostomy).Outer tube is removed on 2nd or 3 rd day depending up on the recovery.

Internal tube is usually removed after couple of weeks.If the surgery is smooth and there are no residual fragments the doctor may opt to skip the internal tube.

Complications are bleeding , infection and residual stones.

Hospital stay is usually 3-4 days.

It is advisable to take bed rest for 2 weeks after a PCNL.

Dr.Tharun
Dr. Tharun, Urology Resident
Category: Urology
Satisfied Customers: 3563
Experience: MBBS, DNB surgery and presently working as Urology resident towards the degree of Urologist.
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