Percutaneous Lithotripsy
This information is intended to help you learn more about a specialized procedure for the removal of kidney stones, called percutaneous nephrostolithotomy (PERC). Although the vast majority of patients with kidney stones can be successfully treated with the kidney stone crusher (shock wave lithotripsy), sometimes the patient's kidney stone problem is better managed with PERC.
The types of kidney stone problems that are better treated with PERC are extremely large kidney stones, difficult to-fragment stones, patients with a blockage in the urinary tract in addition to their kidney stones requiring treatment, or patients in whom shock wave lithotripsy has not been successful in eliminating their stone(s).
The PERC procedure is a specialized operation. Before being scheduled for your surgery, the doctor will discuss the procedure with you and explain why the PERC operation is preferred for your particular problem. During your discussion with the doctor, be sure to ask about any aspects of your treatment that remain unclear to you.
The PERC procedure is done in the operating room. Because insertion of the tube into the kidney is painful and also because the procedure may require several hours (especially for an extremely large stone), general anesthesia is recommended. At the beginning of the PERC procedure, a small catheter is passed through the bladder and up the ureter tube to the kidney. Sometimes a tiny balloon on the catheter tip is inflated to keep stone fragments from moving out of the kidney during the operation. The catheter is also used to fill the kidney with x-ray dye during placement of the PERC tube.
Under x-ray guidance, a tube is then passed through a tiny incision in the back into the kidney. Special scopes are then used to look inside the kidney to locate and remove the stone. When necessary, lasers, ultrasound, or tiny shock waves are used to assist in fragmenting and removing the stone.
The percutaneous operation will usually last one to three hours, depending on the type and extent of the problem being treated. Once the PERC procedure has been completed, a small rubber tube is placed in the kidney to prevent bleeding. The tube is generally left for a few days and is usually removed before the patient is released from the hospital.
Sometimes, when the stone is extremely large or complex, it may be difficult to locate all the fragments at the time of the initial PERC operation. Therefore, x-rays will be taken a day or two after the operation to be certain that all stone fragments have been removed. If any stone particles remain, it may be necessary to re-examine the kidney at the time the nephrostomy tube is removed.
A small amount of bleeding from the kidney will occur when the PERC tube is inserted. The amount of bleeding is usually minor, but there may be some blood in the urine for a few days following the operation. The risk of serious bleeding is very low and even with extensive PERC operations, blood transfusions are necessary in only about one to two percent of cases. Very rarely (one in 500 cases), there may be enough bleeding that specialized x-ray procedures or surgery becomes necessary.
Kidney stones are often associated with urinary infection. For this reason, antibiotics may be prescribed before the PERC operation. In addition, because of the presence of urinary infection, some fever is common for a day or two after the operation. Antibiotics are administered before and after the procedure to minimize the risk of infection, but it is possible that the urinary infection could be aggravated temporarily by the PERC operation.
Even though the incision required for the PERC operation is tiny (one-third of an inch), the procedure is considered invasive, meaning that damage to the kidney, ureter, or nearby organs is possible. Fortunately, the risk of serious complications is very low and much less than older surgical methods for kidney stone removal.
The PERC operation significantly reduces the pain, disability, and recovery time associated with traditional surgery. Most patients are discharged from the hospital two to four days after their PERC. Heavy lifting, straining, or exercising should be avoided for one week following hospital discharge. Return to normal physical activity is usually possible within a week or two following hospital discharge. If severe pain or high fever (more than 101 degrees) is experienced, your urologist should be contacted.
Depending on the type of kidney stone problem treated, antibiotics are commonly prescribed for a week or two following discharge from the hospital. If the kidney stone has been associated with chronic urinary infection, antibiotics may be prescribed for several months.
