Consent: Percutaneous Nephrolithotomy - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent. Overview of Procedure A percutaneous nephrolithotomy is a common urological procedure utilised for the removal of renal calculi, typically for those >3cm in diameter, staghorn calculi, or those unsuccessfully treated by extracorporeal shockwave lithotripsy. The kidney is accessed percutaenosuly under X-ray or ultrasound guidance and a camera is passed through. The stone(s) that need treatment are identified and then obliterated, using either a laser or lithoclast. A nephrostomy tube is then left in situ for a few days that permits the drainage of any blood or urine. Complications Intraoperative Complication Description of Complication Potential Ways to Reduce Risk Haemorrhage Damage to major blood vessels during the procedure; may need suture ligation or, if severe, embolisation or nephrectomy Careful and meticulous technique, identifying major blood vessels Damage to surrounding structures This can be either thoracic (lungs, pleura) or abdominal (bowel, liver, spleen) structures Use of X-Ray or ultrasound guidance for placement of initial guidewire Multiple punctures required Often required in those with complex anatomy to ensure all stones removed Anaesthetic risks Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms a part of the anaesthetist assessment before the operation Early Complication Description of Complication Potential ways to Reduce Risk Infection Infections to the renal tract can be introduced from instrument insertion Maintain an aseptic technique throughout the procedure Haematuria Bleeding from kidney into the collecting system can occur following the procedure; this is often transient Pain Pain from both the operation site and from the nephrostomy tube itself Regular analgesia post-operatively and the use of local anaesthesia around the puncture site Nephrocutaneous fistula formation May occur several days after removal of the nephrostomy tube and can cause leakage of urine; fortunately, this usually spontaneously resolves Frequent questions What is percutaneous nephrolithotomy? Percutaneous nephrolithotomy is a urological procedure used to remove kidney stones that are larger than 3 cm, staghorn calculi, or stones that have not responded to extracorporeal shockwave lithotripsy. The procedure involves accessing the kidney through the skin using imaging guidance, allowing for the identification and treatment of the stones. What are the common complications associated with percutaneous nephrolithotomy? Common complications include haemorrhage, damage to surrounding structures, infection, and nephrocutaneous fistula formation. These risks can be mitigated through careful technique, aseptic practices, and proper post-operative care. How is the kidney accessed during percutaneous nephrolithotomy? The kidney is accessed percutaneously under X-ray or ultrasound guidance, allowing for precise placement of instruments. A camera is then introduced to locate and treat the stones effectively. What measures can be taken to reduce the risk of complications during the procedure? To minimise complications, a meticulous technique should be employed to identify major blood vessels, and aseptic techniques must be maintained throughout. Additionally, the use of imaging guidance can help avoid damage to surrounding structures. What post-operative care is necessary after percutaneous nephrolithotomy? Post-operative care includes managing pain with regular analgesia and monitoring for complications such as haematuria or infection. A nephrostomy tube is typically left in place for a few days to facilitate drainage of blood or urine. Rate This Article