心在山东身在吴Percutaneous Nephrolithotomy
Prior to Surgery
Surgery Scheduling
You will be contacted in the near future by one of the department’s surgery schedulers with the date of the procedure. An appointment will also be made for you at the Preoperative Medicine Clinic (PMC). Shortly thereafter you will receive by mail an informational packet with instructions on where to go for your PMC visit and surgery. Three days prior to surgery you will be contacted by one of OHSU’s OR schedulers with the final surgery time and when to check in the morning of surgery.
Preoperative Testing
During your PMC visit the items listed below will be ordered as deemed necessary bad upon your age and medical history. You will have an opportunity to speak with the anesthesia staff regarding the risks of a general anesthetic.
军训图片- EKG (electrocardiogram)
- CBC (complete blood count)
- PT / PTT (blood coagulation profile)
- Comprehensive Metabolic Panel (blood chemistry profile)
- Urinalysis
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Medications to Discontinue
Unfortunately it is not safe to perform the procedure while taking anti-coagulation (blood thinning) medications. A list of medications that decrea your body’s ability to clot are listed below. All blood thinning medications need to be discontinued at least 5 days prior to surgery to prevent rious bleeding from the kidney and/or nearby organs following the procedure. Do not stop any of the medications without contacting your prescribing doctor for approval. If your prescribing doctor does not feel it is safe for you to discontinue one of the medications plea contact the urology office to let us know. We will discuss with you alternative treatment options such as ureteroscopic lithotripsy, which can be performed while taking blooding thinning medications.
- Vitamin E
- Aspirin
- Aspirin / dipyridamole (Aggrenox) - Ibuprofen (Advil, Motrin)
- Naproxen (Aleve)
- Diclofenac (Voltaren) - Celecoxi (Celebrex) - Rofecoxib (Vioxx)今年头伏
- Clopidogrel (Plavix) - Ticlopidine (Ticlid)
- Warfarin (Coumadin) - Enoxaparin (Lovenox)
Diet Day Before Surgery
You may eat a regular diet until midnight the night before surgery. After midnight plea do not eat or drink anything. If instructed to do so, you may take your prescription medications with a sip of water.
Surgery
Procedure Description
Once asleep a catheter will be placed in your bladder (Foley catheter). You will then be placed on your stomach and a small incision will be made in your back (about 1 inch in length). Through the inc
ision a tube (access sheath) will be placed into the hollow part of your kidney containing the stone(s). An instrument is pasd through the sheath into the kidney, which breaks the stone up and sucks out the pieces.
正宗笔画
Once the stone has been removed a ureteral stent will be placed. A ureteral stent is a piece of surgical plastic that goes from the kidney to the bladder through the ureter (tube that transports urine from the kidney to the bladder). The stent keeps the ureter open following surgery. If a stent is not placed the ureter may temporarily swell shut or become occluded by blood clots or stone debris resulting in kidney pain following surgery or leakage of urine out of the incision site in your back.
The majority of time a nephrostomy tube will also be placed at the end of the procedure. A nephrostomy tube is a drain that rests within the hollow part of the kidney and comes out through the previously made skin incision. Like the ureteral stent, the nephrostomy tube helps ensure that the kidney does not become blocked with blood clots following the procedure. The
tube also minimizes bleeding from the kidney following surgery. Occasionally, a nephrostomy tube will not be placed at the end of the procedure. This depends on a number of factors during surgery.
Hospitalization and Drain Removal
Most patients spend a single night in the hospital and are discharged the afternoon following surgery. Unless there is concern for ongoing bleeding or infection (fevers after surgery) the drainage tubes will usually be removed in the following order.
Nephrostomy Tube Prent
- Nephrostomy tube: the day after surgery while in the hospital
- Bladder Catheter: two days after surgery, either in clinic or at home
- Ureteral Stent: one week after surgery in clinic
No Nephrostomy Tube
- Bladder Catheter: the day after surgery while in the hospital
- Ureteral Stent: one week after surgery in clinic
Potential Risks and Complications包菜的营养价值
Although uncommon, percutaneous stone removal is an invasive surgery with the potential for major
complications. Potential risks include, but are not limited to the following:
Residual Stones within the Kidney or Ureter
The risk of having residual stone following the procedure depends upon the number, size and complexity of the stone(s) being treated. A review of the medical literature published by the American Urological Association found that nearly 25% of patients being treated for large, complex stones had residual fragments following surgery. One study (Raman et al. J Urol 2009; 181: 1163) found that within 3 years of surgery 43% of patients with residual fragments had stone-related symptoms and 26% required another procedure.
Urinary Tract Infection
Intravenous antibiotics will be given to you immediately before surgery. If you have a history of infected kidney stones or recurrent urinary tract infections you made be placed on oral antibiotics the week prior to surgery. In rare instances you may be admitted to the hospital a day or two prior to surgery to receive intravenous antibiotics.
Despite preoperative antibiotics it is always possible to develop a bladder infection (burning with urin
ation, urinary frequency and urgency) or a kidney infection (back pain, fevers, naua, fatigue) after surgery. The likelihood of a rious infection following the procedure is less than 1%. However, the risk may be slightly higher if you have a history of recurrent infections or an infection that was treated prior to surgery.
Bleeding
The procedure involves making a hole in the kidney to remove the stones. As a result, significant bleeding can occur. The risk of losing enough blood to require a transfusion is roughly 3%. This risk may be higher if your blood count prior to surgery is low. Approximately 1% of patients will experience delayed bleeding. This typically occurs 5 to 7 days after surgery and is due to abnormal healing of blood vesls in the kidney. Patients will typically experience the rapid ont of kidney pain with a marked increa in the amount of blood in the urine. An angiogram of the kidney is performed by an Interventional Radiologist, which locates the bleeding vesl. The vesl is then plugged from the inside.
Pleural Effusion
The surgical incision will occasionally have to be made above the ribs to access the stone(s), which r
isks developing a pleural effusion (accumulating fluid around the lung). Incisions above the 12th rib carry a risk of about 5% and incisions above the 11th rib a risk of nearly 30%. Fortunately, it is very rare to have to go above the 11th rib to get into the kidney unless abnormalities of the spine are prent. Small effusions due not require treatment. However, if a large amount of fluid has accumulated around the lung then a parate drainage tube will need to be placed, which usually gets removed a day or two after surgery.
Collecting System Injury
Tearing a hole in the hollow part of the kidney occurs roughly 5% of the time. Small perforations (holes) do not need to be treated. Large perforations require the procedure to be stopped and increa the risk of developing an abscess (collection of infected fluid) around the kidney. Most large perforations heal with no further treatment other than prolonged kidney drainage (leaving the nephrostomy tube, bladder catheter, and stent in longer than usual). Failure to Gain Access
The first part of the procedure is establishing a connection between the skin and the hollow part of the kidney with a plastic tube (sheath). Approximately 1 to 3% of the time this is not successful and the surgery is stopped. Most instances involve patients who are very obe or have abnormal kidney
anatomy. Future treatment options include attempting the procedure at a later date after the kidney has recovered, having the tube placed under CT or ultrasound
guidance at an earlier date, or treating the stone(s) in a different way (ureteroscopic or shock wave lithotripsy).
Injury to Nearby Organs
Injuring structures near the kidney such as the colon, small intestines, liver or spleen has been reported (0.3% of procedures). Loss of the kidney has also been noted but also occurs less than 1% of the time.
安国教育网Following Surgery
Postoperative Symptoms
The vast majority of patients do well after the procedure and are able to go home the day after surgery. The following symptoms can be expected.
Pain
金福实
Most patients experience mild to moderate pain at the surgery site, especially if a nephrostomy (kidney) drain is prent. The pain improves significantly following removal of the nephrostomy tube. Nevertheless, it can take veral weeks for the pain to resolve. Burning with urination typically lasting 24 hours is also common.
The symptoms are usually well controlled with oral narcotic pain medication. If not provided prior to surgery, you will be nt home with a prescription for either Percocet or Vicodin. The medications can impair judgment and reaction time. As a result, you must not drive or operate dangerous equipment while on the medications. You should transition to Acetaminophen (Tylenol) and/or Ibuprofen within a day or two of surgery if possible.
Hematuria
Hematuria (blood in the urine) will always be prent following the procedure and usually lasts until a few days after the ureteral stent is removed. The amount of blood in the urine is typically heaviest over the first one to two days. It is common for the blood in the urine to go completely away and then come back intermittently while the stent remains in place. This is nothing to worry about and is usually due to the stent rubbing up against the inner lining of the kidney, ureter and bladder. As previ
ously mentioned, if you notice a sudden increa in the amount of blood in your urine with worning kidney pain plea contact the urology office or go to the Emergency Department.
Stent Related Symptoms
Nearly all patients will experience symptoms related to the ureteral stent. It is common to feel like you have to urinate more frequently and urgently due to the stent irritating the bladder. You may also feel a dull ache in your kidney when you urinate due to urine backing up the stent into the kidney. Lastly, you may also experience some discomfort in the urethra or tip of the
