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Percutaneous Endoscopy of Kidney
What is
Percutaneous Endoscopy of Kidney?
Percutaneous renal surgery involves the
development of a track from the skin directly
into the kidney.
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Effects
of Percutaneous Endoscopy of Kidney
Only a
small puncture site is needed for percutaneous
endoscopic surgery, and with the advent of
prophylactic antibiotics there are few
complications.
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Candidates for Percutaneous Endoscopy of Kidney
Ideal
candidates for percutaneous surgery are those
with kidney disorders. The most common
indication for percutaneous surgery is to remove
large kidney stones (> 2.5 cm), which cannot be
effectively treated with extracorporeal
shockwave lithotripsy (SWL) or in patients in
whom SWL has failed. Any form of anatomical
obstruction of the kidney associated with a
kidney stone is also best treated primarily with
percutaneous surgery.
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Your Consultation
A
thorough history should be obtained and a
physical examination should be performed prior
to any procedure. Special attention should be
paid to the following historical factors:
anticoagulation, bleeding disorders, contrast
medium reactions, malignancy, obesity, spinal
cord injury, and history of urinary tract
infections. Essential laboratory data include a
coagulation profile, complete blood cell count,
electrolytes, blood urea nitrogen, creatinine,
platelet count, urinalysis, and urine culture.
Appropriate antibiotic coverage before and on
call during the procedure is useful in
preventing intraoperative sepsis.
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The
Percutaneous Endoscopy of Kidney Procedure
Simple
percutaneous renal access procedures are
performed with the patient in the prone position
while under a combination of local anesthetic
and intravenous sedation. Percutaneous renal
surgery involves the development of a track
(usually 1 cm in width) from the skin directly
into the kidney. The endourologist then looks
directly into the kidney through this track and
is able to treat certain kidney disorders.
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Recovery
Patients typically remain in the hospital for a
day or two after percutaneous surgery and are
able to return to their regular activities in a
week or two instead of the one to two months
recuperative period required for open surgery.
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Risks
Postoperatively, patients should be monitored
for bleeding, especially in the recovery room. A
chest x-ray should be part of the routine
postoperative management due to the risk of a
pleural tear or perforation when supracostal
percutaneous access is obtained. If a
pneumothorax or hydrothorax is present,
pleurocentesis or placement of a small-diameter
thoracostomy tube may be required. Prophylactic
antibiotics routinely are continued
postoperatively until all tubes are removed and
all puncture sites are healed.
Frequently Asked Questions
Q:
What is a kidney?
A:
The
kidneys are
bean-shaped
excretory
organs in
vertebrates. Part of the
urinary system, the kidneys filter wastes
(such as
urea) from the
blood and excrete them, along with
water, as
urine.
Q:
What is percutaneous surgery?
A:
Percutaneous
surgery is based on needle and guidewire access
to the kidney and the upper urinary tract. Once
guidewire access is obtained, various catheters
can then be placed into the kidney, either for
drainage or to facilitate antegrade intrarenal
or ureteral endoscopic procedures. The tract
must first be established and should provide a
straightforward route to the kidney, allowing
bloodless instrumentation. If more than renal
drainage is desired, endoscopic surgery can then
continue as a single or staged procedure. With
recent advances, many invasive open urologic
procedures now are performed endoscopically
through small-diameter percutaneous access
tracts.
Q:
What are the advantages of endoscopic surgery?
A:
The major advantage of endoscopic surgery is
that by using small or no incisions to treat a
urologic disorder, the convalescence period from
surgery is reduced and the patient is able to
resume regular activities sooner than if open
surgery was performed.
The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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