Prof. Dr. Mustafa SOFİKERİM | Urology

Percutaneous Nephrolithotripsy (PNL)

Especially when renal calculus is larger than 2 cm in the kidney, it can cause difficulties for the patient. Then, the calculus is broken with the lithotriptor device called the ESWL, or such a large calculus is poured from the urine channels. As stated in the guide for the diagnosis and treatment of renal calculus diseases published by European Urology Association, the first choice for treatment of stones (calculus) larger than 2cm inside the kidney should be percutaneous nephrolithotripsy (PNL). On the other hand, for stones larger than 1,5 cm in the renal bottom pelvis, PNL should be recommended as a choice of treatment and negotiated with the patient. The PNL method of renal calculus has been a surgical treatment applied to a large number of patients all over the world for long years. It is a safe method which has replaced the stone therapy with open surgery for almost most of the patients inflected with renal calculus.

In PNL, the kidney system is accessed where the renal calculus stone is located through a needle, then a guide wire is inserted through this needle. The needle is removed and an amplatz dilatation system is placed on this guide wire to form a channel approximately 1 cm in diameter. By means of this system, a 1 cm diameter tube is inserted into the kidney through the endoscope and the stones in the kidney are broken by laser or pneumatic lithotriptor and the broken stone pieces are taken out of the pipe path. Nephrostomy catheter is placed in the system temporarily (1-2 days) to ensure urine drainage and rapid recovery after the procedure. This method provides an effective and reliable treatment for kidney stones or stones as a technique that causes little harm to the patient.

After PNL, operation-related pain is short and less, and the duration of hospital stay and daily activities and return to work are significantly shorter than open surgery. Usually the nephrostomy tube is removed on the 2nd or 3rd day after the operation and the patient is discharged after several hours of wetting through the hole has disappeared.

PNL application is made by a surgeon who is experienced in PNL. The most important reason for this is to give the least damage to the kidney during surgery and also to completely remove the stones in the kidneys and prevent further calculus formation. There may be some leftovers in some large stones and they are cleaned with an extra PNL session in an early period, or small stones are treated with ESWL.

Flexble Ureterorenocopy (Rirc, Retrograd Intrarenal Surgery)

The flexible ureterorenoscopy (RIRC) involves a very thin telescope that can be crimped, penetration into the ureter and the kidney through the urinary tract, without breaking any holes, and the fracture or removal of the stone by the laser. The flexible ureterorenoscopy physician can control all the chambers in the kidney by controlling the folding end of the instrument with one hand under the perfect image provided by the camera connected to the device and can reach the calculus formations and break them by laser. After this operation, a catheter (DJ stent) is inserted into the kidney, which enables the fracture of the broken stones to be taken out more safely and provides an uneventful recovery of the kidney and the ureter canal and is taken by endoscopic method after 2-4 weeks depending on the condition of the patient and the treatment.

Rigid Ureterorenoscopy (RIGID-URS)

The rigid ureterorenoscopy involves a very thin telescope that does not bend and enters into the ureter without breaking any holes in the body, and breaks or receives the stone by means of a laser.

Rigid ureterorenoscopy is a long and very thin endoscopy device. The thickness of rigid ureteroscopes can be up to 1-1.5 cm, but 0.8-1.3 cm endoscopes are used more frequently. The image is wider and the angle is 0-10 ° and the working channel is slightly thicker than the curved endoscope and can rise to 1.5 mm. Due to the fact that there are two working channels which are a little thicker, it is possible to use the devices more quickly and easily and to break and take the stone. However, the most important limitation is that it cannot be twisted and only provides treatment for the fracture and removal of stones in the ureter canal. There is no use efficiency in the kidney stones, as it does not have the ability to curl.