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Percutaneous Nephrolithotomy (PCNL) Kidney stones are formed in the urinary tract due to the crystallization of chemical compounds in the urine. PCNL is a technique used to remove certain stones in the kidney or upper ureter (the tube that drains urine from the kidney to the bladder) that are too large for other forms of stone treatment such as shock wave lithotripsy or ureteroscopy. The Surgery This procedure has been performed on many patients over the last several years and is an accepted standard of care for patients with kidney stones that are large, very firm, or resistant to other forms of stone treatment. As such it has replaced open operations for kidney stones in the vast majority of patients. Typically, the length of the surgery is one to two hours. The surgery is performed by making a small 1 cm incision in the patient’s flank area. A tube is placed through the incision into the kidney under x-ray guidance with the help of a C-Arm. A small telescope is then passed through the tube in order to visualize the stone, break it up and remove it from the body. If necessary a laser or other device called a lithotripter may be used to break up the stone before it can be removed. This procedure has resulted in significantly less post-operative pain, shorter hospital stays, and an earlier return to work and daily activities when compared to open stone surgery. This technique also has a higher success rate for clearing all stones in one setting than other techniques such as extracorporeal shock wave lithotripsy (ESWL), which often require several attempts. Potential Risks and Complications Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to open surgery. Potential risks include: Bleeding Infection Tissue / Organ Injury Conversion to open surgery Failure to Remove the Stone

Hernia repair surgery is the world’s most common surgical procedure. Hernia surgery can help to relieve pain, return the hernia abdominal organs to their correct place and, strengthen the weak muscle area. A hernia operation usually takes around an hour as a day case procedure. It can be performed by: • Open surgery – under local or general anaesthetic, an incision usually around 2.5 to 3 inches is made to your skin near your hernia and your surgeon will push your hernia back into your abdomen. The incision is then either stitched closed or much more commonly a mesh is placed over the hole and fixed using fine stitches. The mesh acts like a scaffold and your own tissue will grow through the mesh to reinforce the weakened area without putting tension on the surrounding tissues. • Keyhole (laparoscopic) surgery – under general anaesthetic, several smaller incisions are made to allow surgeon to use a less invasive technique using various special instruments including a tiny telescopic camera to repair your hernia. A mesh may then be used to strengthen your abdominal wall. If hernia surgery is recommended, we will advise on the most appropriate type of surgery based on the location and severity of your hernia.