Travel for Healing: Percutaneous Nephrolithotomy with Safe & Hassle-Free Care

Percutaneous nephrolithotomy in India

Percutaneous Nephrolithotomy (PCNL) is a less invasive surgery that is applied to remove large or complicated kidney stones, which cannot be effectively treated with the other interventions such as medication, Extracorporeal Shock Wave Lithotripsy (ESWL), or Ureteroscopy.

Key Points:

• Procedure: The patient has a minor laceration done in the back- about 1 cm and directly over the kidney.
• Access: This incision is entered with the assistance of a thin tube (nephroscope) into the kidney.
• Stone Removal: It entails the breaking of the kidney stones with specialized tools or lasers followed by extraction of the stones.
• Drainage: Sometimes a nephrostomy tube or stent is temporarily left in position to drain urine to aid healing.

Indications:

PCNL is most commonly advised in case of:

• Kidney stones larger than 2 cm
• Staghhorn calculi (stones in the branches and renal pelvis)
• Refractory stones.
• Multiple or complex stones

Advantages:

• Better clearance rate of the stones than the non-invasive techniques.
• Less invasive than open surgery.
• Faster recovery period than open procedures.

PCNL surgery in India

Percutaneous Nephrolithotomy (PCNL) surgery is a less invasive operation carried out to eliminate the large, complicated, or stubborn kidney stones. It is the procedure whereby the back is cut into a small opening to reach the kidney and remove or disintegrate stones.

PCNL Surgery Procedure

• Anaesthesia - This patient receives general anaesthesia or regional.
• Positioning - The patient rests in face down (prone position).
• Kidney Access - A small (approximately 1 cm) incision is achieved on the back and a needle is inserted into the kidney with the help of ultrasound or X-ray imaging.
• Insertion of nephroscope - A nephroscope (one with a camera and a thin tube) is inserted into the kidney.

Stone Removal –

• The ultrasound, laser or pneumatic devices are used to break the stones.
• Suction or forceps are used in removing small fragments.
• Drainage Tube/Stent: A nephrostomy tube or ureteral stent can be inserted to allow the healing to drain well.

Factors Affecting Cost of percutaneous nephrolithotomy in India

The following is a breakdown of the Factors Affecting Percutaneous Nephrolithotomy (PCNL) Cost:

Hospital and Location

• Hospital type Multispecialty hospitals and internationally accredited centers generally are more expensive than smaller clinics.
• Geographic location: Prices are quite diverse depending on the city or country (hospitals located in urban metro are more expensive).

Surgeon’s Expertise

• Urologists that are highly qualified and properly trained in endourology may want to charge above average fees.
• The cost can be raised by the complex cases that need senior specialists.

Type and Size of Stone

• Stone size: Calculi that are larger or staghorn may require increased instruments, extended surgery, and even more than one surgery.
• Stone complexity: Stone complexity increases the time and cost of procedures by being irregular, multiple, or hard to reach.

Type of Procedure

• Standard PCNL vs. Mini-PCNL (smaller track, less invasive) vs. Ultra-mini PCNL.
• The use of Tubeless PCNL (no drainage tube) can decrease the cost and length of stay in hospitals.

Anaesthesia Charges

• General anaesthesia is generally necessary and increases total cost.
• The length of anaesthesia is determined by the complexity of a surgical procedure.

Hospital Stay

• Average stay: 2–4 days.
• Increased cost is caused by longer stay because of complications (bleeding, infection, second operation).

Assigned Equipment and Technology

• It is more expensive when using advanced tools such as laser lithotripters, ultrasonic devices or high-definition imaging.
• There are also disposable instruments and nephrostomy tubes that increase the costs.

Pre- and Post-Surgery Tests

• Blood, urine testing, imaging (X-ray, CT, ultrasound), and ECG.
• Postoperative imaging to ensure clearance of the stones.

Drugs and Surgical Attention

• Antibiotics, paincontrol, and intravenous fluids in hospitalization.
• The cost is increased by the post-surgery process of stent removal or follows up.

Best hospitals for PCNL surgery in India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Kidney stone removal surgery in India

Removal surgery on kidney stones is conducted to remove the stones which are too large to be cleared through natural means, pain, infection, or obstruction in the passage of urine. The type and the location of the stone and the health condition of the patient determine the type of surgery to be used.

Surgeries to remove kidney stones can be of the following types:

Ureteroscopy (URS)

• Procedure: Via the urethra and the bladder, a skinny scope (urethroscopes) is inserted to access the stone in the ureter or kidney. The stone is removed with a little basket or it is broken with the help of a laser (laser lithotripsy).
• Anaesthesia: General anaesthesia or spinal anaesthesia.
• Recovery Time: 1–3 days.
• Indications: Stones in the ureters or the kidney (up to 2 cm).

Percutaneous Nephrolithotomy (PCNL)

• Procedure: A small incision (approximately 1 cm) is created at the back to insert a nephroscope right into the kidney. Ultrasonic or laser energy is used to break stones and remove them.
• Anaesthesia: General.
• Recovery Time: 3–5 days.
• Indicated: Large stones (>2 cm) or several stones.

Shock Wave Lithotripsy (SWL or ESWL)

• Operation: The use of high-energy shock waves is directed in the outside due to which the stone is broken down into smaller fragments that are carried through urine naturally.
• Anaesthesia: Mild or sedation anaesthesia.
• Recovery Time: 1–2 days.
• Ideal In: Small to medium stones (<2 cm) in the upper ureter or kidney.

Stone Removal Laparoscopic or Robotic

• Procedure: It is carried out through laparoscopic or robotic instruments through keyhole incisions in instances when other less invasive techniques have failed.
• Anaesthesia: General.
• Recovery Time: 3–7 days.
• Ideal: Large and complex stones or where other procedures cannot be applied.

Open Surgery (Rarely Used)

• Procedure: Standard incision is done to take out stones on the kidney itself.
• Anaesthesia: General.
• Recovery Time: 1–2 weeks.
• Best In: Large or frequent rocks where alternative methods cannot be used.

Factors Affecting Affordable PCNL treatment in India

Here are the key factors that affect the affordability of PCNL (Percutaneous Nephrolithotomy) treatment in India:

• Hospital Type & Location
• Surgeon’s Expertise & Reputation
• Stone Size, Number, Complexity, & Location
• Pre-operative Diagnostics & Tests
• Hospital Stay Duration & Room Category
• Type of PCNL Procedure & Equipment Used
• Anaesthesia, OT (Operating Theatre) Charges, & Personnel
• Post-operative Care / Complications
• Medications / Consumables
• Additional Costs (Logistics, Travel, Accommodation)

Percutaneous nephrolithotomy treatment in India GetWellGo

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