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Yeh kya hai aur kyun kiya jata hai
PCNL mein surgeon peeth ki jild mein aik chhota cut lagata hai aur seedha gurde tak aik tang raasta banata hai. Is raaste se aik patli doorbeen guzaari jati hai, aur pathri ko laser ya kisi aur taaqat se tora ja kar tukre nikaal liye jate hain.
Yeh zyadatar bari ya pechida gurde ki pathrion ke liye istemal hoti hai, ya jab doosre ilaaj jaise shock wave (ESWL) ya ureteroscopy (URS) munasib na hon ya kaam na karein. Aap ka urologist batayega ke aap ki pathri ke liye PCNL behtareen kyun hai (dekhein gurde ki pathri ki guide).
Yeh URS ya ESWL se bara operation hai, lekin ek chhote se raaste se bari pathrion ko zyada behtar tareeqe se saaf karta hai.
Procedure se pehle
- Pehle peshab aur khoon ke tests hote hain. Peshab ke infection ka operation se pehle ilaaj hota hai, aur khoon ke tests se gurdon aur khoon ki ginti ki jaanch hoti hai (dekhein peshab ke tests ki guide).
- Scans: gurde tak raasta tay karne ke liye aam tor par CT scan chahiye hota hai (dekhein CT scans). Apne scans aur reports saath layein.
- Khoon patla karne wali dawayein: kisi bhi khoon patla karne wali dawa aur allergy ke baare mein team ko batayein. Apne taur par koi dawa band na karein. Khoon behne ke khatre ki wajah se in dawaon ko ehtiyaat se sambhalna padta hai.
- Bay-hoshi: PCNL poori bay-hoshi (general anaesthetic) mein hoti hai. Khaane peene ke baare mein jo hidayaat milein un par amal karein.
- Aap se razamandi (consent) maangi jayegi. Khatrat, kitni raatein hospital mein rehna hoga, aur mazeed ilaaj ki zaroorat ke baare mein poochhne ka yehi waqt hai.
- Qeemat aur operation kahan hoga, yeh bhi poochh lein.
Procedure ke dauran
Aap soye hote hain. Aksar pehle bladder se ureter mein aik patli nali rakhi jati hai. Phir aap ko is tarah lita jata hai, aksar pait ke bal ya karwat par, ke surgeon peeth ki taraf se gurde tak pohanch sake.
X-ray ya ultrasound ki rehnumai mein aik sui gurde mein dali jati hai aur raaste ko chora karke aik tang raasta (sheath) banaya jata hai. Is sheath se doorbeen guzaari jati hai, pathri laser ya kisi aur taaqat se tori jati hai aur tukre nikaal liye jate hain.
Aakhir mein kabhi kabhi gurde mein aik nikaasi ki nali (nephrostomy tube) chhodi jati hai jo peeth se bahar aa kar thaili mein jati hai, ya us ki jagah DJ stent lagaya jata hai. Yeh gurde ko nikaasi dene aur theek hone mein madad karte hain.
Procedure ke baad aur recovery
- Hospital mein qayam: zyadatar log chand din hospital mein rehte hain. Dard ka ilaaj hota hai, aur team peshab ke rang aur nikaasi ki nali ko dekhti rehti hai.
- Peshab mein khoon kuch din aam hai aur shuru mein kaafi surkh ho sakta hai. Bohat paani peeyein, siwaye is ke ke aap se kam karne ko kaha gaya ho.
- Peeth mein cut ke aas paas dard ya sozish aam hai. Aam dard kam karne wali dawayein aksar kaafi hoti hain.
- Nali aur patti: agar nali chhodi gayi ho to team batayegi ke woh kitni der rahegi aur patti ki dekh-bhal kaise karni hai. Nali ko na kheenchein na alag karein, aur thaili ko gurde se neeche rakhein.
- Normal zindagi par wapsi: kayi haftay ya mashware ke mutabiq bhaari wazan uthane aur zor wali kasrat se parhez karein. Kaam, gaari aur safar ke baare mein team se poochh lein.
Mumkina khatrat
- Aam: peshab mein khoon, peeth mein cut ki jagah sozish, aur dard ki dawa ki zaroorat.
- Kam aam: peshab ka infection ya bukhar, khoon ka behna jis par gehri nigrani ya kabhi khoon charhane ki zaroorat ho, aur pathri ke bache hue tukre jin ke liye mazeed ilaaj chahiye.
- Bohat kam: qareeb ke kisi ang jaise phephre ya aant ko chot, gurde ko chot jis ke liye doosra procedure chahiye ho, khoon mein phailne wala shadeed infection, ya operation rok kar baad mein poora karna.
PCNL doosre pathri ke ilaajon se bara operation hai, is liye khatrat zara zyada hain, lekin yeh aksar bari pathri saaf karne ka sab se behtareen tareeqa hota hai. Aap ka urologist un khatrat par baat karega jo aap par lagoo hote hain.
Follow-up aur pathri ke nateeje
- Nali ya stent: agar aap nali ya stent ke saath ghar jayen to poochh lein ke kaun nikalega, kab, aur aap ko kaise bulaya jayega. Stent ko waqt par nikalwana ya badalwana zaroori hai (dekhein DJ stent ki guide).
- Jaanch ka scan: aksar baad mein scan tay hota hai taake dekha jaye ke koi pathri baqi to nahi. Agar kuch baqi ho to mazeed ilaaj tay ho sakta hai.
- Pathri ka tajzia: pathri ke tukre laboratory bheje ja sakte hain. Poochh lein ke nateeja kaise bataya jayega (dekhein 24 ghante ka peshab aur pathri ka tajzia).
- Nayi pathri se bachao: kaafi paani peena sab se ahem qadam hai. Aap ka urologist mazeed mashwaray de sakta hai.
Fauran madad kab lein
Agar in mein se koi bhi ho to fauran qareebi hospital ke emergency department jayein, ya us unit se raabta karein jis ne operation kiya:
- Bukhar, kapkapi ya bohat bimar mehsoos karna (dekhein urinary tract infection guide).
- Pehlu ya kamar mein shadeed dard jo aam dard kam karne wali dawaon se kam na ho, ya dard ke saath ulti.
- Aap peshab nahi kar pa rahe, ya bohat kam kar rahe hain (dekhein urinary retention guide).
- Zyada khoon behna, gehra surkh peshab ya lothray jo peshab rok dein.
- Nali nikal jaye, nikaasi band ho jaye, ya patti ke aas paas se bohat zyada paani ya khoon nikalne lage.
- Seene mein dard ya saans lene mein mushkil.
Chand din tak peshab mein khoon ka rang aur cut ki jagah sozish aam baat hai aur emergency ki zaroorat nahi.
Aam sawalaat
Kya mujhe dard hoga?
Operation ke dauran aap soye hote hain. Baad mein peeth mein sozish hoti hai aur dard ki dawa di jati hai. Zyadatar logon mein yeh chand dinon mein behtar ho jata hai.
Cut kitna bara hota hai?
Yeh peeth ki jild mein aik chhota keyhole cut hota hai, purane khule operation se bohat chhota.
Hospital mein kitna rehna hoga?
Aam tor par chand din, lekin yeh aap ki recovery aur nali chhodi gayi ho ya nahi us par munhasir hai. Team aap ko batayegi.
Kya saari pathri nikal jayegi?
Maqsad pathri ko saaf karna hota hai, lekin kabhi chhote tukre reh jate hain aur mazeed ilaaj chahiye hota hai. Baad ka scan yeh dikhata hai.
Kaam par kab wapas ja sakta hoon?
Yeh aap ke kaam aur recovery par munhasir hai. Zyadatar logon ko bhaari kaam se kuch haftay door rehna padta hai. Team se poochh lein.
Kya pathri dobara ban sakti hai?
Haan, pathri dobara ban sakti hai. Kaafi paani peena aur urologist ke mashwaray par amal karna imkaan kam karta hai (dekhein gurde ki pathri ki guide).
What it is and why it is done
In PCNL the surgeon makes a small cut in the skin of the back and creates a narrow channel straight into the kidney. A thin telescope is passed down this channel, and the stone is broken with a laser or other energy and the pieces are removed.
It is used mainly for larger or more complex kidney stones, or when other treatments such as shock waves (ESWL) or ureteroscopy (URS) are not suitable or have not worked. Your urologist will explain why PCNL is the best option for your stone (see the kidney stones guide).
It is a bigger operation than URS or ESWL, but it clears large stones more effectively through one small opening.
Before the procedure
- A urine test and blood tests are done first. A urine infection is treated before the operation, and blood tests check your kidneys and blood count (see the urine tests guide).
- Scans: a CT scan is usually needed to plan the route into the kidney (see CT scans). Bring your scans and reports.
- Blood thinners: tell the team about any blood-thinning medicine and any allergies. Please do not stop any medicine on your own. These medicines usually have to be managed carefully because of the risk of bleeding.
- Anaesthetic: PCNL is done under general anaesthetic. Follow the instructions about eating and drinking.
- You will be asked for consent. This is the time to ask about the risks, how many nights you will stay, and the possibility of further treatment.
- Ask about the cost and where the operation will be done.
During the procedure
You are asleep. Often a thin tube is first placed up the ureter from the bladder. You are then positioned, often lying on your front or side, so the surgeon can reach the kidney from the back.
Guided by X-ray or ultrasound, a needle is passed into the kidney and the track is widened to make a narrow channel (a sheath). The telescope goes down the sheath, the stone is broken with a laser or other energy, and the pieces are removed.
At the end, a drainage tube (a nephrostomy tube) is sometimes left in the kidney and comes out through the back into a bag, or a DJ stent is placed instead. These help the kidney drain and heal.
After the procedure and recovery
- Hospital stay: most people stay in hospital for a few days. You will have pain relief, and the team will watch the urine colour and any drain.
- Blood in the urine is expected for some days and may be quite red at first. Drink plenty of water unless told otherwise.
- Pain or soreness in the back around the cut is common. Simple pain relief usually controls it.
- Tube and dressing: if a tube is left in, the team will explain how long it stays and how to look after the dressing. Do not pull or disconnect it, and keep the bag below the level of the kidney.
- Getting back to normal: avoid heavy lifting and strenuous exercise for several weeks, or as advised. Ask the team about work, driving and travel.
Possible risks
- Common: blood in the urine, soreness at the site in the back, and a need for pain relief.
- Less common: a urine infection or fever, bleeding that needs close watching or, occasionally, a blood transfusion, and leftover stone pieces that need more treatment.
- Rare: injury to a nearby organ such as the lung or bowel, injury to the kidney that needs another procedure, a serious infection that spreads into the blood, or the need to stop the operation and finish it later.
PCNL is a bigger operation than the other stone treatments, so the risks are a little higher, but it is often the most effective way to clear a large stone. Your urologist will talk through the risks that apply to you.
Follow-up and stone results
- Tube or stent: if you leave with a tube or stent, ask who will remove it, when, and how you will be contacted. A stent must be removed or changed on time (see the DJ stent guide).
- Check scan: a scan is often arranged afterwards to see whether any stone is left. If some is left, more treatment may be planned.
- Stone analysis: pieces of stone may be sent to the laboratory. Ask how you will be told (see 24-hour urine and stone analysis).
- Preventing new stones: drinking enough water is the main step. Your urologist may suggest more.
When to seek urgent help
Please go to the nearest hospital emergency department, or contact the unit that did your operation, if any of these happen:
- Fever, shivering or feeling very unwell (see the urinary tract infection guide).
- Severe pain in the side or back that usual pain relief does not settle, or pain with vomiting.
- You cannot pass urine, or are passing very little (see the urinary retention guide).
- Heavy bleeding, bright red urine or clots that block the flow of urine.
- The tube falls out, stops draining, or leaks a lot of fluid or blood around the dressing.
- Chest pain or difficulty breathing.
Blood-stained urine and soreness at the cut for a few days are expected and do not need an emergency visit.
Common questions
Will I feel pain?
You are asleep during the operation. Afterwards there is soreness in the back and pain relief is given. Most people find it settles over days.
How big is the cut?
It is a small keyhole cut in the skin of the back, much smaller than a traditional open operation.
How long will I stay in hospital?
Usually a few days, but it depends on your recovery and whether a tube was left in. The team will tell you.
Will all of the stone be removed?
The aim is to clear the stone, but sometimes small pieces remain and more treatment is needed. A check scan afterwards shows this.
When can I go back to work?
It depends on your job and recovery. Most people need some weeks away from heavy work. Ask the team.
Can the stone come back?
Yes, stones can come back. Drinking enough water and following your urologist's advice lower the chance (see the kidney stones guide).