Percutaneous Nephrolithotomy in Korea

Percutaneous Nephrolithotomy in Korea


Percutaneous Nephrolithotomy (PCNL) is a highly effective minimally invasive surgical procedure used to remove large or complex kidney stones. In Korea, PCNL is a widely utilized and advanced treatment option for kidney stones that are too large or too hard to be treated by less invasive methods, offering excellent stone-free rates and direct removal of stones.


Understanding Kidney Stones & Indications in Korea

Kidney stones are hard deposits that form in the kidneys and can cause significant pain and complications.

  • Formation: Stones form when urine becomes concentrated, allowing minerals (e.g., calcium, oxalate, uric acid) to crystallize.
  • Symptoms: Severe flank pain (renal colic), blood in urine, nausea, vomiting, and sometimes fever and chills if infection is present.
  • Indications for PCNL: Primarily recommended for:
  • Large Kidney Stones: Typically stones larger than 2 cm.
  • Complex Stones: Such as staghorn calculi (which fill part or all of the kidney's collecting system).
  • Stones Resistant to Other Treatments: When less invasive options like ESWL (shockwave lithotripsy) or Ureteroscopy are unlikely to be effective or have failed.
  • Stones in Difficult Locations: For example, in lower pole calyces.
  • Diagnosis: In Korea, diagnosis involves imaging (CT scan is gold standard for stone detection and planning, also KUB X-ray, ultrasound), urinalysis (for infection), and blood tests (kidney function).


Common Surgical Procedure in Korea

PCNL involves creating a small tract from the skin directly into the kidney.

  • Procedure:
  1. Anesthesia: Performed under general anesthesia.
  2. Access to Kidney: The patient is positioned (often prone or supine), and a small incision (typically 1-2 cm) is made in the back or flank. Using X-ray or ultrasound guidance, a needle is inserted through the skin, kidney tissue, and into the kidney's collecting system.
  3. Tract Dilation: The needle tract is then progressively dilated to create a working channel large enough for instruments.
  4. Nephroscope Insertion: A nephroscope (a specialized endoscope) is inserted through the tract into the kidney.
  5. Stone Removal: Stones are visualized directly. They may be fragmented using laser, ultrasonic, or pneumatic lithotripters, and the fragments are then removed using graspers or suction.
  6. Drainage/Stent: A nephrostomy tube (a tube left in the kidney to drain urine) or a ureteral stent may be placed temporarily to ensure drainage and healing.
  • Mechanism: Allows direct visualization and removal of large or complex stones in one procedure.
  • Variations: Mini-PCNL uses smaller instruments and tracts for smaller, but still complex, stones.


Recovery & Outcomes in Korea

Recovery from PCNL is generally good, with high stone-free rates.

  • Hospital Stay: Typically 3-7 days, depending on stone complexity and patient recovery.
  • Post-Op Pain: Managed with pain medication. Mild discomfort in the flank is common.
  • Drainage Tube/Stent: Nephrostomy tubes are usually removed within 1-3 days. Ureteral stents may remain for 1-2 weeks.
  • Activity: Light activities can be resumed relatively quickly, but strenuous activities are restricted for several weeks.
  • Stone-Free Rates: PCNL boasts high stone-free rates, often 85-95% for most stones, and remains the most effective method for very large or complex calculi.
  • Complications: While safe, potential complications include bleeding (which may require transfusion), infection, adjacent organ injury (rare), or residual stone fragments.


Korean Guidelines & Practice

PCNL is a well-established and frequently performed procedure in Korean urology.

  • Expert Centers: Performed by highly experienced urologists in major university hospitals and specialized stone centers.
  • Comprehensive Stone Management: PCNL is part of a complete kidney stone management algorithm, with specialists choosing the most appropriate treatment based on stone size, location, and patient factors.
  • Advanced Technology: Access to state-of-the-art lithotripters and endoscopic equipment.
  • National Health Insurance: PCNL for medically indicated kidney stones is generally covered by Korea's national health insurance.


Key Takeaways for PCNL in Korea

To summarize the essential points about Percutaneous Nephrolithotomy in Korea:

  • Removes Large/Complex Stones: Gold standard for significant kidney stones.
  • Minimally Invasive: Involves a small incision in the back for direct access to the kidney.
  • High Success Rates: Offers excellent stone-free outcomes in a single procedure.
  • Specialized Care: Performed by expert urologists in well-equipped centers.

We hope this guide clarifies Percutaneous Nephrolithotomy in Korea. Always consult a qualified medical professional for personalized advice, diagnosis, and treatment options for kidney stones.