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Urology
Percutaneous Nephrolithotomy
Definition
Percutaneous nephrolithotomy, or PCNL, is a procedure for removing medium-sized or larger renal calculi (kidney stones) from the patient's urinary tract by means of an nephroscope passed into the kidney through a track created in the patient's back. PCNL was first performed in Sweden in 1973 as a less invasive alternative to open surgery on the kidneys. The term "percutaneous" means that the procedure is done through the skin. Nephrolithotomy is a term formed from two Greek words that mean "kidney" and "removing stones by cutting."
Purpose
AThe purpose of PCNL is the removal of renal calculi in order to relieve pain, bleeding into or obstruction of the urinary tract, and/or urinary tract infections resulting from blockages. Kidney stones range in size from microscopic groups of crystals to objects as large as golf balls. Most calculi, however, pass through the urinary tract without causing problems.
Renal calculi are formed when the urine becomes supersaturated (overloaded) with mineral compounds that can form stones. This supersaturation may occur because the patient has low urinary output, is excreting too much salt, or has very acid urine. Urolithiasis is the medical term for the formation of kidney stones; the word is also sometimes used to refer to disease conditions associated with kidney stones.
There are several different types of kidney stones, in terms of chemical composition : -
- Calcium oxalate calculi : - About 80% of calculi found in patients are formed from calcium combined with oxalate, which is a salt formed from oxalic acid. Some foods, such as rhubarb and spinach, are high in oxalic acid. Oxalic acid is also formed in the body when vitamin C is broken down. Oxalic acid is ordinarily excreted through the urine but may be absorbed in large amounts due to chronic pancreatic disease or surgery involving the small intestine.
- Uric acid calculi : - These stones develop from crystals of uric acid that form in highly acidic urine.
- Uric acid calculi account for about 5% of kidney stones. In addition, some kidney stones are a combination of calcium oxalate and uric acid crystals.
- Cystine calculi : - Cystine calculi represent about 2% of kidney stones. Cystine is an amino acid found in proteins that may form hexagonal crystals in the urine when it is excreted in excessive amounts. Kidney stones made of cystine indicate that the patient has cystinuria, a hereditary condition in which the kidneys do not reabsorb this amino acid.
- Struvite calculi : - Struvite is a hard crystalline form of magnesium aluminum phosphate. Kidney stones made of this substance are formed in patients with urinary tract infections caused by certain types of bacteria. Struvite calculi are also known as infection calculi for this reason.
Staghorn calculi. Staghorn calculi are large branched calculi composed of struvite. They are often discussed separately because their size and shape complicate their removal from the urinary tract.
Some people are more likely than others to develop renal calculi.Risk factors for kidney stones include : -
- Male sex.
- Family history. Having a first-degree relative with urolithiasis increases a person's risk of developing kidney stones.
- Age over 30.
- Diet. People whose diet is high in protein or who eat foods rich in oxalate are more likely to develop kidney stones.
- Dehydration. People who do not drink enough fluid each day to replace what is lost through perspiration and excretion produce very concentrated urine. It is easier for crystals to form in concentrated than in dilute urine, and to grow into kidney stones.
- Metabolic disorders affecting the body's excretion of salt or its absorption of calcium or oxalate. Most cases of urolithiasis in children are related to metabolic disorders.
- Intestinal bypass surgery and ostomies. People who have had these surgical procedures lose larger than average amounts of water from the digestive tract.
Demographics
kidney stones are found in about 1% of bodies at autopsy. An estimated 10% of the population will suffer from kidney stones at some point in life. For reasons that are not yet known, Although more men develop renal calculi in general than women, more women develop infection calculi than men.
In terms of age groups, most people with urolithiasis are between the ages of 20 and 40; kidney stones are rare in children.
For more information, medical assessment and medical quote
send your detailed medical history and medical reports
as email attachment to
Email : - info@wecareindia.com
Call: +91 9029304141 (10 am. To 8 pm. IST)
(Only for international patients seeking treatment in India)
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