Principles of the procedure
This procedure is performed to remove large or multiple stones in the kidney that are not easily treated by other means (ESWL or ureteropyeloscopy). A small incision (1.5cm) is made in the flank and the kidney collecting system is directly accessed via a hollow tube (‘sheath’) and a telescope. This enables the best chance of complete stone clearance for larger stones. A tube draining the kidney via the incision site (‘a nephrostomy’) is inserted at the end of the procedure and is usually removed the second day following the surgery.
Pre-operative preparation
You will be admitted on the day of the procedure. You will need a recent urine test (within 2 weeks of the surgery) to ensure that you do not have a urine infection. No other specific preparation is needed apart from fasting about 6 hours prior to the surgery. You should continue to take your usual medications unless directed by your urologist or his anaesthetist. Please inform us if you are taking any anticoagulant (blood thinning) medication.
Expected post-operative recovery
When you wake up from the surgery, you will have a nephrostomy tube draining the kidney as well as a catheter draining the bladder. These are sequentially removed over the 2 days following the surgery. Sometimes a small leak of urine can occur from the nephrostomy site, though this always settles but occasionally will need an absorbent dressing.
Blood staining of the urine often occurs after the procedure, though this almost always settles by keeping your intake of fluids up.
Risks – as per your discussion with your Urologist
Bleeding
Severe bleeding requiring embolisation or (very rarely) loss of kidney
Infection
Ureteric injury
Need for repeat procedure for complete stone clearance (very large stones)
Bowel or lung injury
Anaesthetic risks, Pressure area risks