Stone Extraction Ureteroscopy and PCNL ERAS

Stone extraction ureteroscopy and percutaneous nephrolithonomy (PCNL) are minimally invasive surgical procedures for recurrent kidney stones. A ureteroscopy involves passing a small scope into your ureter and breaking up the stones with a laser, while PCNL uses a slightly larger video scope passed directly into your kidney from your back to remove large stones.

Our stone extraction ureteroscopy and percutaneous nephrolithonomy (PCNL) ERAS program is designed to help patients return to health more quickly after undergoing the procedures.

Prior to Surgery

• Your surgeon will meet with you to explain surgical plans and set your expectations for surgery.
  • Contact your surgeon via MyChart or call the surgical clinic with questions: 214-645-8765.
• We will call you to provide instructions for surgery and medications prior to surgery. You might also be scheduled for an appointment in our pre-surgical testing clinic to meet with our anesthesia team or have blood drawn.
  • We might request testing from your other physicians.
  • Call our pre-surgical testing clinic with any questions: 214-633-4202.
• Lifestyle modifications:
  • We encourage you to stop smoking and consuming alcohol for one month prior to surgery.
  • We encourage you to increase your physical activity prior to surgery.
  • Eat a balanced, healthy diet, and remain hydrated.
• On the night before surgery, do not eat solid foods after 11 p.m.
• Follow any instructions directly from your surgeon.
• You can drink clear liquids up to 20 ounces (such as water, Gatorade, or Sprite) up to two hours before your surgery start time.
• In the pre-op area, you will receive oral non-narcotic pain medications (acetaminophen and methocarbamol) to improve your postoperative pain.

During Surgery

• You will receive general anesthesia and be completely asleep during the procedure.
• Your anesthesia team will monitor you very closely while you are asleep and will insert additional intravenous (IV) lines or monitors if necessary.
• You will receive multiple medications during surgery to treat pain and nausea.
• There will be a specific and tailored anesthetic protocol to decrease the stress on your body, improve pain control, and accelerate your recovery.
• Local anesthetics will be placed at the surgical site by your surgeon. This is designed to decrease your postoperative pain and need for IV and oral pain medications.

Post-Anesthesia Care Unit (PACU) and After

• You will wake up in our post-anesthesia care unit (PACU).
• You will be asked to chew gum and ice chips and drink clear liquids to help with recovery of bowel function.
• You will be given an incentive spirometer to remind you to take deep breaths.
• Starting on the day of your surgery, we encourage you to get out of bed and walk with help from your nurse.
  • Try to increase the distance and frequency of your walks each day; doing so will help your bowel function return to normal, prevent deconditioning, and speed up your recovery.
• Unless instructed otherwise by your nurse or surgeon, you will be able to eat a normal diet the day of your surgery. Continue to chew gum or hard candy as well.
• You will take scheduled non-opioid pain medications during your recovery and have narcotic medications available for breakthrough pain if necessary.
• For ureteroscopy patients, we expect that after some time in the PACU, you will proceed to day surgery. When you meet the criteria for discharge, you will be discharged home, typically on the same day of your procedure.
• For patients having a PCNL, you will go from the PACU to a patient room, with a specialized plan to hasten your recovery and optimize your care.