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Percutaneous Nephrolithotomy Pre- and Postoperative Instructions

Prior to Surgery

What to Expect during Your Preoperative Consultation

During your initial consultation with your surgeon, he or she will review your medical history as well as any outside reports, records and X-ray films (e.g., CT scan, MRI, sonogram). A brief physical examination will also be performed at the time of your visit. If your surgeon determines that you are a candidate for this procedure, you will then meet with a patient service surgery coordinator to arrange for the date of your procedure.

Note: It is very important that you bring all of your X-ray films and reports to the initial consultation with your surgeon.

What to Expect prior to Surgery

Since insurance companies will not permit patients to be admitted to the hospital the day before surgery to have tests completed, you must make an appointment to have preoperative testing done at your family doctor or primary care physician's office within one month prior to the date of surgery.

For The Johns Hopkins Hospital: These results need to be faxed by your doctor's office to the Preoperative Evaluation Center at 443-287-9358 two weeks prior to your surgery. Please call the Documentation Center at 410-955-9453 two weeks before your surgery date to confirm that this information was received.

Once your surgical date is secured, you will receive a form along with a letter of explanation to take to your primary care physician or family doctor in order to have the following preoperative testing done prior to your surgery:

  • Physical exam
  • Electrocardiogram (EKG)
  • Complete blood count (CBC)
  • Blood coagulation profile (PT/PTT)
  • Comprehensive metabolic panel (blood chemistry profile)
  • Urinalysis

Preparation for Surgery

Medications to avoid prior to surgery
Aspirin, Motrin, ibuprofen, Advil, Alka-Seltzer, vitamin E, Ticlid, Coumadin, Lovenox, Celebrex, Voltaren, Vioxx, Plavix and some other arthritis medications can cause bleeding and should be avoided one week prior to the date of surgery. (Please contact your surgeon’s office if you are unsure about which medications to stop prior to surgery. Do not stop any medication without contacting the prescribing doctor to get their approval.)

It is very important that your last urine culture was negative prior to having this procedure. Please call the physician’s office at least one week before this procedure to confirm your urine culture results. If you suspect that you may have a urinary tract infection, please call the physician office immediately so that proper antibiotics can be prescribed before your surgery.


What to Expect after Surgery

During Your Hospitalization

Immediately after the surgery you will be taken to the recovery room, then transferred to your hospital room once you are fully awake and your vital signs are stable.

  • Postoperative pain: Pain medication can be controlled and delivered by the patient via an intravenous catheter or by injection (pain shot) administered by the nursing staff.
  • Nephrostomy tube: You can expect to have a small tube called a nephrostomy tube coming out of your back to allow urine to drain from the kidney into a drainage bag. The nephrostomy tube typically remains in place for one to two days. There is a possibility that you will be discharged from the hospital with the nephrostomy tube, as deemed necessary by your surgeon.
  • Stent: You may have an internal ureteral stent in place within the ureter between the kidney to the bladder to promote drainage from the kidney. This will be removed in your surgeon’s office in typically one to two weeks following surgery.
  • Nausea: You may experience some nausea related to the anesthesia. Medication is available to treat persistent nausea.
  • Urinary catheter: You can expect to have a urinary catheter draining your bladder (which is placed in the operating room while you are asleep) for approximately one day after the surgery. It is not uncommon to have blood-tinged urine for a several days after surgery.
  • Diet: You can expect to have an intravenous (IV) catheter in for one to two days. (An IV is a small tube placed into your vein so that you can receive necessary fluids and stay well hydrated until you are able to tolerate a diet; it also provides a way to receive medication.) Most patients are able to tolerate ice chips and small sips of liquids the day of the surgery and regular food the next day. Once on a regular diet, pain medication can be given by mouth instead of by IV or shot.
  • Fatigue is common and should subside in a few weeks following surgery.
  • Incentive spirometry: You will be expected to do some very simple breathing exercises to help prevent respiratory infections by using an incentive spirometry device (these exercises will be explained to you during your hospital stay). Coughing and deep breathing are an important part of your recuperation and help prevent pneumonia and other pulmonary complications.
  • Ambulation: On the day after your surgery it is very important to get out of bed and begin walking with the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can expect to have sequential compression devices (SCDs) along with tight white stockings on your legs to help prevent blood clots.
  • Hospital stay: The length of hospital stay for most patients is approximately one to two days.
  • Constipation: You may experience sluggish bowels for several days or several weeks following surgery. Suppositories and stool softeners can be taken to help with this problem. Taking mineral oil at home will also help to prevent constipation. 
  • Secondary procedures: Some patients have stones that are very large or that cannot be safely removed at one setting. You may need a "second look" operation to remove any remaining stones, either during the hospitalization or at another visit. 

What to Expect after Discharge from the Hospital

  • Pain control: You can expect to have some pain that may require pain medication for a few days after discharge. Most patients, however, find that Tylenol is sufficient to control the incisional pain.
  • Showering: You may shower at home. Your wound site can get wet but must be padded dry afterwards. Tub baths can soak your incision and therefore are not recommended in the first two weeks after surgery. 
  • Activity: Taking daily walks is advised. Prolonged sitting or lying in bed should be avoided. Climbing stairs is possible but should be taken slowly. Driving should be avoided for at least one to two weeks after surgery. After this time, activity can begin as tolerated. You can expect to return to work as soon as one to two weeks following surgery or as instructed by your physician.
  • Follow-up appointment: You will need to call the Johns Hopkins Outpatient Center (410-955-6707) or Johns Hopkins Bayview (410-550-7008) soon after your discharge to schedule a follow-up visit.
  • Stent follow-up: The length of time the stent remains in place is variable. Your doctor will probably request that it be removed within a one- to four-week period. This can be removed in the doctor's office. It is common to feel a slight amount of flank fullness and urgency to void as a result of the stent. These symptoms often improve over time as the body adjusts to the indwelling stent. It is critical that patients return to have their stent removed as instructed by their physician, as a prolonged indwelling ureteral stent can result in encrustation by stone debris, infection and obstruction of the kidney.
  • Nephrostomy site care: If you are discharged home with a nephrostomy in place, it is important that urine flow freely through the tube. Check daily to make sure the tube is not kinked. Make sure the stopcock, if present, remains in the open position to allow urine to drain from the kidney. Keep the tube securely anchored o the skin with tape to prevent pulling and to keep the tube in place. Monitor the amount of drainage and color. Blood-tinged urine is not uncommon. Keep the drainage bag below the level of the kidney at all times. It is important to clean the area around the insertion site with mild soap and water each day when you shower. Pat the area dry after showering and clean directly around the insertion site with hydrogen peroxide using a cotton tip applicator. Apply a clean sterile dressing after cleaning the area. If you experience any change in pain, fever, chills, pus forming around the insertion site, the catheter not draining or leaking around the tube, you must contact your doctor immediately.

Our Surgeons

Photo of Dr. Brian Richard Matlaga, M.D., M.P.H.

Matlaga, Brian Richard, M.D., M.P.H.

Professor of Urology
Director, The Stephens Center for Stone Disease
Expertise, Disease and Conditions: Benign Prostatic Hyperplasia (BPH), Endourology, Kidney Stones, Urology
 

Appointments

To make an appointment for consultation, please call 410-955-6100.

Directions to The Johns Hopkins Hospital.

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