Sometimes our kidneys have small problems. Sometimes things like stones. So today we are going to talk about a method that can be used to see what is happening inside the kidneys and treat them. This is called (Nephroscopy) . Let's see what it is, how it is done, and what you need to know.
What exactly is Nephroscopy?
Simply put, a nephroscopy is a procedure used to look inside your kidneys and treat certain conditions, especially problems in the upper part of the renal system. Think of it like putting a small camera inside your kidneys.
A small, special instrument called a nephroscope is used for this. It is like a thin tube. This tube is inserted through a small incision in your skin, on the outside. Inside this nephroscope, there is a light source to see clearly, a small telescope-like part to look inside, and an irrigation system . This water system is used to keep the area where the operation is being performed clean, which is like washing and cleaning it.
Then , ultrasound or a laser probe is sent through this nephroscope to break up the target inside the kidney, such as a kidney stone. After being crushed in this way, the pieces are either sucked out through a channel in the nephroscope or grasped with a forceps-like device (graspers) .
Thanks to this method (Nephroscopy), the need for open surgery, which involves large incisions like in the past, has been greatly reduced. Isn't that a big advantage? Because the work can be done through a small incision, you can recover faster.
When is nephroscopy used?
Nephroscopy is used specifically to remove small kidney stones. This is called percutaneous nephrolithotomy (PCNL) . This involves making a small incision in the skin, inserting a nephroscope through it, and removing stones that are one centimeter (about one-third of an inch) or larger.
Not only that, but this (Nephroscopy) helps with many other things:
- If there are any remaining kidney stone fragments from the previous procedure, remove them.
- Remove small tumors that form in the kidneys.
- Remove any foreign bodies, such as a stent that was previously inserted for some reason.
- Remove kidney cysts ( small sacs filled with fluid on or inside the kidney).
- Treat a condition called Ureteropelvic Junction (UPJ) obstruction . Simply put, this is a blockage at the junction where urine flows from the main collection point of the kidney (renal pelvis) to the tube that carries urine down to the bladder (ureter). This blockage can prevent urine from flowing down properly, causing the kidney to swell.
- If a previous (PCNL) surgery was performed, this method is also used to check whether it was successful and whether any stone fragments remain.
Where is this done? In the hospital?
If a nephroscopy is being performed as a diagnostic test or as a follow-up procedure, it can be done on an outpatient basis . This means that you don't have to stay in the hospital.
However, if you are doing this with a (PCNL), that is, if you are removing the stone, it is done in a hospital . Then you will be given general anesthesia . After that, you will have to stay in the hospital for about a day and then go home.
How do you prepare for this?
Now let's see how you should prepare for this (Nephroscopy). Is this also very important?
- First, you can have a urine test . This will check for any infection in your urine.
- If you have an infection, you will be given antibiotics to treat the infection. Because it's not good to have an infection during an operation.
- Another thing is, if you are taking blood-thinning medications like aspirin , you will be asked to stop taking them at least a week before the surgery.
- Also, if you are taking other antiplatelet drugs, such as warfarin (Coumadin®) , you will need to stop taking them as well. But your urologist will tell you exactly when and how to stop taking these. It is best to do as they say.
- Finally, it is best not to eat or drink anything for 8 hours before the surgery. Your stomach should be empty. This is very important for anesthesia.
How exactly is a nephroscopy performed?
This is a bit detailed, but I'll keep it simple.
Your urologist will first review recent scans of your kidneys and urinary system (for example, a CT scan or a urogram ) to prepare for this surgery.
On the day of your surgery, you will be given general anesthesia . You will then be placed face down on the operating table.
Next, a small catheter is inserted through your urethra into your kidney. A special dye is then injected through the catheter and X-rays are taken. This allows you to see clearly what's inside your kidney.
As planned, a needle is inserted through the skin of your back into the exact location of your kidney. After the area is dilated , a sheath (a tube-like tube) is inserted. This is inserted through a small incision about the size of a dime. The nephroscope and other surgical instruments are passed through this sheath directly into the kidney.
Then, the target of the surgery (i.e., a kidney stone or blockage) is broken up and crushed, or completely removed, through the nephroscope.
After surgery, you may have a urethral stent placed inside your kidney. A stent is a soft, hollow plastic tube about 10 to 12 inches long. It is placed in your ureter ( the tube that carries urine from your kidney to your bladder). The stent helps keep the urethra open. This helps urine flow better and helps the kidney heal faster. The stent is usually removed in your doctor's office after about a week .
What happens after the operation?
After the surgery, you will be taken to the recovery room . There, the medical staff will take good care of you until you wake up from the anesthesia. They will also monitor you for any internal bleeding. Antibiotics will also be continued during this time.
When will you be able to go home?
The day you go home depends on the reason for your nephroscopy. In most cases, you can go home the day after the surgery . However, your doctor will tell you how long you will need to stay in the hospital, depending on your condition.
What are the things you need to take care of when you go home?
You still need to be a little careful after you go home. Be aware of these things:
- If you develop a fever, feel cold , or have severe pain that cannot be controlled with the painkillers your doctor has prescribed, call your doctor immediately.
- If you notice a lot of blood in your urine, or if you see blood clots , go to the emergency room immediately.
- Unless your doctor advises otherwise, avoid lifting weights or doing strenuous exercise for two to four weeks.
What are the benefits and risks of this?
Like any medical procedure, Nephroscopy can have both benefits and minor risks.
Benefits:
Nephroscopy is a very safe procedure. In particular, it greatly reduces the need for traditional surgery, which involves large incisions. Major surgeries take longer to heal and are more likely to cause infection. So, Nephroscopy is a very good option in that regard.
Risks:
Although generally low, there may be some risks. These are:
- Sometimes there can be serious bleeding . If that happens, a blood transfusion may be necessary.
- Fluid buildup in your lungs can occur. If this happens, it will need to be removed with a needle or tube.
- A serious infection called sepsis can occur.
- Urinary tract infection may occur.
- Rarely, there may be an injury to the ureter or kidney .
But don't worry. Your doctor will discuss all of this with you and decide what's best for you.
Take-Home Message
So, Nephroscopy is a very safe and effective procedure that helps remove problems inside the kidneys, especially stones. Since it can be done through a small incision, rather than a large one, you can recover quickly. Although there are some risks with every medical procedure, the most important thing is to talk to your doctor and know everything before you go in. If you have any questions or doubts, don't be afraid to ask your doctor.
` Kidney stones, nephroscopy, PCNL, kidney surgery, urinary system, kidney health, surgery
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