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Pyelolithotomy Surgery

Pyelolithotomy is a surgical procedure to treat a stone in the renal pelvis. Indications for pyelolithotomy include minimally branched staghorn stones in the renal pelvis of complex collecting systems and excessive morbid obesity.

Pyelolithotomy is a surgical procedure to treat a stone in the renal pelvis. ... Read More

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What is Pyelolithotomy?

Pyelolithotomy is a surgical procedure used to remove stones that are located in the renal pelvis. It involves making an incision in the abdomen to reach the kidneys and removing the stones from within, rather than using non-invasive methods such as shockwave lithotripsy.

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What are the Types of Pyelolithotomy?

There are two main types of pyelolithotomy:

Open Pyelolithotomy: This is a traditional surgical technique that involves making an incision in the flank of the abdomen to access the kidney and remove the stone.
Laparoscopic Pyelolithotomy: This is a minimally invasive surgical technique that uses small incisions and a laparoscope (a thin, flexible tube with a camera and light) to access and remove the stone.

What Happens in Pyelolithotomy?

Pyelolithotomy involves making an incision in the back to access the stone, then using a stone-cutting instrument, laser, or another tool to break up and remove the stone.

Once all pieces of the stone are removed, a stent may be placed and antibiotics are prescribed as needed depending on what type of infection was present before surgery.

After this procedure, patients may need physical therapy to strengthen weakened muscles while they recover from their surgery.

Diagnosis

Several tests performed before the pyelolithotomy procedure include:

Blood tests: To check kidney function, electrolyte levels, and red and white blood cell counts.
Urine tests: To check for signs of infection and the presence of blood or crystals in the urine.
Imaging tests: Imaging tests such as X-rays, CT scans, or ultrasounds to visualise the kidney and the stones.
Urodynamic tests: To assess bladder and urethral function and rule out any underlying conditions that may affect the surgery’s outcome.
Electrocardiogram (ECG): To assess the heart’s function and identify any underlying heart conditions that may increase the risk of complications during surgery.
Anaesthesia evaluation: To assess the patient’s overall health and determine the appropriate type and dosage of anaesthesia for the surgery.

During the Surgical Procedure

Pyelolithotomy is of different types. Their procedures are mentioned below :

Open Pyelolithotomy is an open surgical procedure in which an incision is made in the side or abdomen, and the surgeon gets direct access to the kidney. The surgeon then removes the stones from the kidney.
Percutaneous pyelolithotomy is a minimally invasive surgical procedure in which the surgeon makes a small incision and passes a scope and a tube through the skin into the kidney. The surgeon then removes the stones from the kidney through the tube. The procedure is less invasive and requires a shorter recovery time than open pyelolithotomy.

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How to Prepare for Pyelolithotomy?

Here’s how you can prepare for pyelolithotomy:

Consult with your doctor: Before preparing for surgery, it is important to consult with your doctor about the procedure, its risks, and its benefits. You should also discuss any medical conditions or medications that you are taking that may affect the surgery.
Follow preoperative instructions: Your doctor will provide you with specific preoperative instructions to follow, such as fasting before surgery, stopping certain medications, and avoiding smoking.
Get plenty of rest: In the days leading up to surgery, it is important to get plenty of rest and avoid strenuous activities that could increase your risk of injury.
Stay hydrated: Drinking plenty of water in the days leading up to surgery can help keep you hydrated and reduce the risk of complications during surgery.
Stay positive: Surgery can be a stressful experience, but staying positive and focusing on the benefits of the procedure can help reduce anxiety and improve your overall outlook.

What to Expect After Pyelolithotomy?

Patients may expect these changes following pyelolithotomy:

After the surgery, patients may feel some discomfort or pain, which can be managed with pain medication. They may also experience some swelling or bruising around the incision site, which should subside over time.
Patients may need to stay in the hospital for a few days after the surgery to recover and get monitored for any complications.

What are the Benefits of Pyelolithotomy?

Here are some of the benefits of pyelolithotomy:

Effective removal of large stones: Pyelolithotomy is highly effective in removing large stones that cannot be treated with non-invasive methods. This procedure allows the surgeon to access the renal pelvis directly and remove the stones using specialised instruments.
Reduced risk of complications: Unlike non-invasive methods, Pyelolithotomy is a surgical procedure that requires general anaesthesia and a longer recovery time. However, it is associated with a lower risk of complications such as bleeding, infection, and damage to surrounding organs.
Improved kidney function: Stones can cause significant damage to the renal pelvis and impair kidney function. Pyelolithotomy can help restore normal kidney function by removing the stones and improving urine flow.
Prevention of future stone formation: Pyelolithotomy can also help prevent the formation of future kidney stones by removing any stones that may be present in the renal pelvis.
Improved quality of life: Kidney stones can cause severe pain, discomfort, and other symptoms that can significantly impact a patient’s quality of life. Pyelolithotomy can help alleviate these symptoms and improve the overall quality of life.

What are the Side Effects of Pyelolithotomy?

Some possible side effects of pyelolithotomy surgery include:

Bleeding: The surgery may cause excessive bleeding, especially in patients who have blood clotting disorders.
Infection: The surgical site is at risk for infection after the procedure, which can cause pain, fever, and other symptoms.
Urinary tract problems: Patients may experience issues with urination, including pain, difficulty passing urine, and incontinence.
Kidney damage: During the procedure, there may be damage to the surrounding tissues, including the kidneys. This may lead to long-term complications.
Reaction to anaesthesia: Some patients may have an allergic reaction to anaesthesia, which can cause breathing problems, low blood pressure, and other issues.
Scar tissue formation: Surgery can result in scarring that may cause pain, restriction of movement, and other issues.
Nausea and vomiting: Patients may experience nausea and vomiting due to the effects of anaesthesia.

Who Can Undergo Pyelolithotomy?

It is important that individuals considering pyelolithotomy meet certain criteria, such as having:

Stones in the lower portion of the kidneys.
Stones that have been present for at least two months.
Stones larger than 5 mm in size.
No evidence of urinary tract infection.
Normal kidney function
Individuals with certain medical conditions may not be eligible for the procedure due to an increased risk of complications.

What Happens if Pyelolithotomy is Not Done on Time?

If kidney stones are not treated on time, they can lead to various complications. These can include:

Increased pain: As kidney stones grow and block the ureter, the pain can become intense and unbearable.
Urinary tract infections: Kidney stones can increase the risk of urinary tract infections, which can be challenging to treat.
Kidney damage: If the kidney stones are not treated, they can damage the kidneys over time, leading to chronic kidney disease.
Blockage of urine flow: Large kidney stones can completely block the urine flow, which can be a medical emergency.
Severe complications: In rare cases, untreated kidney stones can lead to serious complications, such as sepsis or kidney failure.

What should you not do after Pyelolithotomy?

You are not advised to do the following:

Don’t lift heavy objects or engage in strenuous physical activity for at least four to six weeks after surgery.
Avoid smoking, drinking alcohol, or taking drugs that may interfere with your recovery or increase your risk of infection.
Don’t take a bath, swim, or immerse in water until your surgeon gives you the green light to do so.
Don’t drive until you are cleared by your surgeon to do so safely.
Don’t ignore any signs of infection, such as fever, increased pain, redness, or swelling around the surgical site. Contact your surgeon immediately if you suspect an infection.

Recovery After Pyelolithotomy

Recovery after surgery for renal pelvis stones can vary depending on the size and location of the stones, as well as the type of surgery performed.

In general, patients can expect some discomfort, pain, and fatigue after surgery, which can last for several days to a week or more.
Pain medication may be prescribed to manage pain, and antibiotics may be prescribed if there is a risk of infection.
To facilitate recovery, patients are typically advised to drink plenty of fluids, rest as much as possible, and avoid heavy lifting and strenuous activity for at least a few weeks.
In addition, patients may need to follow a special diet to prevent future kidney stones. This may involve drinking more fluids and avoiding certain foods, such as those rich in oxalate (e.g. spinach, nuts, and chocolate).
It is important to follow any specific instructions provided by your doctor or surgeon and to attend follow-up appointments to monitor your recovery and ensure that the stones do not return.

Frequently Asked Questions

Can Pyelolithotomy be performed on both kidneys at the same time?

Yes, pyelolithotomy can be performed on both kidneys at the same time if necessary.

What are the benefits of pyelolithotomy over other kidney stone treatments?

Pyelolithotomy is a more effective treatment for large kidney stones, and it has a lower risk of recurrence compared to other treatments.

How long does it take to recover after pyelolithotomy?

Recovery time varies, but most people can return to normal activities within 4-6 weeks.

Is pyelolithotomy a permanent solution for kidney stones?

While pyelolithotomy can effectively remove large kidney stones, it does not prevent the formation of new stones in the future.

Are there any dietary restrictions after pyelolithotomy?

Your doctor may recommend dietary changes to reduce the risk of kidney stone formation, but there are no other restrictions after pyelolithotomy.

How often do kidney stones recur after pyelolithotomy?

The recurrence rate varies, but pyelolithotomy has a lower risk of kidney stone recurrence compared to other kidney stone treatments.

How does pyelolithotomy compare to other surgical treatments for kidney stones?

Pyelolithotomy is a more invasive procedure compared to other treatments, but it is more effective in removing large kidney stones. Your doctor can help determine the best treatment option for your specific case.