Minimally invasive treatment of large kidney stones, through a puncture a camera and a laser are introduced into the kidney to pulverize the urinary stones.
Percutaneous nephrolithotomy
It is a procedure reserved for large kidney stones or calculi that are difficult to access or cannot be treated by ureteroscopy or RIRS (Retrograde Intrarenal Surgery).
It consists of percutaneous puncture of the kidney guided by real-time X-ray and ultrasound to access the kidney stones, using an instrument attached to a camera, called a nephroscope, through which a laser fiber is introduced to fragment and pulverize the stones, extracting fragments for analysis using specialized equipment. Other types of energy, such as ultrasonic or ballistic, can also be used.
This procedure offers success rates in stone removal of between seventy and one hundred percent for large stones. It is performed under anesthesia with a very small incision, usually a couple of centimeters, and currently, with the miniaturization of instruments, it is even possible with incisions smaller than one centimeter, using minipercutaneous surgical techniques.
Some variants of percutaneous surgery allow the coupling of aspiration systems, for the extraction of fragments and "sand" formed, while the procedure is being carried out, thus achieving the extraction of stone residue.
The hospital stay is usually one or two days, with a generally positive recovery. Sometimes a drain called a nephrostomy tube is left in place and removed before hospital discharge, along with a ureteral catheter to improve urine flow and facilitate the passage of fragments.
This procedure requires endourologists with specific training and can also be used for the antegrade treatment of ureteral stones and conditions of ureteropelvic junction stenosis, ureteral strictures, and ureteropelvic junction stenosis.
