Who is eligible for pyelolithotomy?

Pyelolithotomy is a surgical procedure that involved the removal of kidney stones from the renal pelvis of the affected kidney. The surgery is done on a patient suffering from pyelonephritis.

Pyelonephritis arises as a result of bacterial infection, resulting in an inflammation on the lining of the renal pelvis and in the parenchyma of their kidney. This infection often begins with affecting the lower urinary tract, beginning from the urethra or bladder and subsequently extending to the kidneys.

Bacteria such as E. Coli enter the urinary tract through the urethra and multiply in such a way that they spread to the bladder and move into the urethra and kidneys. In acute cases of pyelonephritis, they enter the bloodstream and create damaging effects on the kidneys.

If you are experiencing pains in your abdomen including your back and side region, burning or painful urination, with urine which looks cloudy, having drops of blood and/or foul smell then it might be an indication of pyelonephritis. Other symptoms to look out for are nausea, vomiting, fatigue, body aches, chills, and moist skin. 

Contact your doctor for proper diagnosis once you do not feel well and have relatable symptoms. An extreme case of the condition requires pyelolithotomy.

Reasons for a Pyelolithotomy

Pyelolithotomy is required when branched staghorn stones are needed to be removed in the renal pelvis where excess morbid obesity and composite collecting systems have been formed. The surgery is also conducted during retroperitoneal or abdominal surgeries.

Types of Pyelolithotomy

• Laparoscopic pyelolithotomy

This is usually performed on patients who have large single renal-pelvic calculus and renal anomalies. 

• Open pyelolithotomy 

This is conducted on complex stones that cause blockage or symptoms such as pain and recurrent infection which are resistive less invasive treatments.

Doctor’s Examination

When a doctor suspects a patient has some renal challenges, based on their complaint, first they will examine the patient to see if he/she has common symptoms like fever, abdominal pains, or tenderness, and may further require them to undergo a urine test. The test will check for the presence and concentration of bacteria, blood, and pus in the urine.

If results show the above, then the doctor could require imagery of the patient’s excretory organs to check for obstructions in the urinary tract which can be in form of cysts, tumors, or other blockages. Therefore, they would order an ultrasound on you for further examination.

In the case where the doctor suspects scarring of the kidney resulting from pyelonephritis, they may require the patient undergoes a dimercaptosuccinic acid (DMSA) test. DMSA is an imaging method where radioactive material is injected through a vein in the arm and monitored as the material travels to the kidneys, showing the scarred or infected areas.

When the diagnosis shows that the case of pyelonephritis is severe and cannot be treated through drug therapy, the surgical treatment–pyelolithotomy, will be recommended.

Pyelolithotomy Procedure

When the patient does not respond to hospitalization treatment, a doctor’s recommendation is to embark on pyelolithotomy to remove the kidney stones in the affected kidney and regularize any other issues within the system. 

The surgeon will go through your medical history to see if you are fit for the surgery. You will be advised to stay off some medications like nonsteroidal anti-inflammatory drugs and to stop some habits like smoking and alcohol intake for like 3 weeks before the surgery.

Before the surgery,

On admission, you will be informed about the surgical procedures and estimated duration. To prevent clotting and aid circulation of blood, you may have to wear T.E.D. stockings. 

You might be required to learn special breathing for after surgery exercises. If need be, they should shave the surface area where the surgery will be conducted. 

You will take some tablets before the theatre is administered by an anesthetist. These may help to prevent pain and reduce tension and nausea.

During the surgery, 

You will be sedated with general anesthesia, and an IV drip will be connected to you which will help prevent any infection. Your heart and blood rate will be monitored to confirm that you are stable all through the process.

• A flank incision is usually made to allow for the best possible access. This exposes the kidney and ureter, enabling the surgeon to feel for the stones and locate its exact position. 
• An incision is further made into the kidney or ureter to enable the removal of stones. 
• After this, the incisions are stitched and closed. 
• Thereafter, the stitches are dissolved with surgical staples to close the surface skin layers. 
• The wound is then drained and a nephrostomy tube is placed into the kidney using the incision used to remove the stones. 
• The surgeon then makes stitches into place and creates a connection to a drainage bag that enables the drainage of urine, blood, or stone fragments from the kidney. 

After the surgery, 

You will be moved to your recovery room to recoup from your sedated state. Pain or discomfort is relieved as quickly and easily as possible with pain relievers. You may have to be in the hospital for a few days to weeks to be monitored till you are confirmed fit to go back how.

Recovery

Being fully healed from a pyelolithotomy can take months. The duration depends on your body type and the severity of your kidney stones. You will have to stick to the dietary and lifestyle plans as directed by your surgeon. 

Take 2 to 3 weeks off from work after surgery and hard work to avoid exertion on your surgical area. Take good care of your incision, keep it dry and sanitized until it completely healed, to avoid infection.

Make sure to visit your doctor for follow-up checkups till he sees that you do not need to have them anymore. Laboratory and imaging tests are run on the kidneys each visit, to ascertain their state.

Risks Factors

During pyelolithotomy, the patient may lose some blood because large blood is usually being supplied to the kidneys and there is a risk of losing blood with every surgery. In some of the cases, blood loss during surgery is compensated through blood transfusion. 

Sometimes, the channel within the ureter may be narrowed as a result of a surgical incision when a stone is lodged firmly within the ureter and results in scarring. The narrowing is known as urethral stricture. Another risk that may arise is the puncturing of the lung. 

Because the upper part of the kidneys sits close to the lungs, pyelolithotomy may lead to deflation of the lung as a result of puncturing which may result from the mistargeted incision, during the surgery.

In some cases, the removal of all deposits of stones may be futile, therefore further surgery may be needed before all of them can be completely removed. 

FAQs

• What is pyelo?

This is another term for kidney infection or pyelonephritis.

• What is the renal pelvis?

This is the tube connected to the enlarged upper end of the ureter, through which urine flows from the kidney to the urinary bladder. 

• Where are giant kidney stones?

These are large stones formed from the high level of urinal minerals and salts, often measured at 5mm or larger. They block the urethra hindering the flow of urine and this can lead to complications.

• Who is eligible for pyelolithotomy?

A patient with kidney stones that are blocking the urinal tract, which causes discomfort in passing out urine and chronic abdominal pains. 

• How long does the surgical procedure take?

Pyelolithotomy can take 2 to 4 hours depending on how severe the kidney infection and stones are.