Hi Boxer,
It really just depends on what your doc is comfortable (and you) doing when it comes to surgery. Generally, when stones are over 1cm, the PCNL or open surgery is usually the best way to go. Lithotripsy, generally, is not a good thing for a stone that big. You just end up having repeat procedures done (like me) and then you are left with tons of pieces that may or may not get flushed all the way out. If they don't come out, more pieces start sticking together and growing and then you are right back where you started, possibly with an even bigger stone.
The PCNL (percutaneous nephrolithotomy) is where they make about an inch incision in your back right above the kidney where the stone is. Then, they can put instruments in the tiny incision and dilate it and open the kidney, again with a tiny incision and then dilate that. Most of the time, the stone can be taken out whole. If it's too big (yours may be and depending on location of stone) they can break the stone up and suck the pieces out through the instruments.
You have a tube that comes out of your back called a nephrostomy tube that drains your kidney. Everytime you move, it hurts like hell, at least it did for me. Probably because I was just sooooo sensitive with that kidney. That was the kidney that was eventually removed. Average hospitalization time is 3-5 days, that is, if everything goes as planned...i.e., no infection, no fever. Sometimes, more than one access incision is needed. It just depends on the situation. The more incisions, the more neph tubes you have.
When I had mine done, they put me to sleep for a while so the interventionalist radiologist could put the neph tube in. Then the next day, I had the surgery. Sometimes, they can do it all at once. Just depends on the surgeon and his schedule. I must warn you though. This was the
WORST procedure I have
EVER HAD! This was because the surgeon promised he had already talked to the hospital PM team and I would be set up with a PCA pump and given liberal amounts of meds due to my tolerance and currents meds.
WRONG!!!! He didn't talk to the PM team and I wake up in recovery
SCREAMING MY HEAD OFF!! The recovery nurse was like "we already given her 50mg of Demerol, she should be out". Are you kidding me???
Well, the surgeon comes in and I'm yelling at him, my husband and mother are also yelling at him, the nurses are yelling at him because my b/p is 250/150 and they think I'm about to stroke out!
Well, 30 minutes go by (seemed like an eternity) and my b/p is still climbing and I'm still screaming and my family is a nervous wreck. Finally, the PM team comes in and hooks up my PCA pump full of Dilaudid. I kid you not, it took 15 mg of Dilaudid spread out in 5 mg doses in 30 minutes to finally take the edge off. I was still miserable. Don't leave it up to the surgeon to make sure you will be taken care of in recovery. Us chronic pain patients, as you know, make docs and nurses very paranoid with the doses we need. I remember one of the nurses telling me they have seen people die with just 1 mg of Dilaudid. I said "you don't know
ANYTHING about me or my situation. I'm not going to die on you. Look at my med chart". She did and said "you poor thing, your are an addict".
WHAAAATTTTT!!!! Totally idiots!!!!! This is just so sad that the med profession does not know the difference between dependency and addiction and I was in NO mood to explain. This is not something you should say to a post-op patient that is in horrendous pain and stroke level b/p. I basically told her to get her a** away from me before she ends up on the floor from me punching her in the face!
Anyway, whatever you decide to do please talk to the PM team
BEFORE your surgery and have a plan in writing! That is one mistake I have never made again. By the way, I never went back to the SOB doc, either!
If you have anymore questions, ask away, ok?? Talk to ya later!!
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