Kidney stones are a common problem in the United States. Up to one in ten people will have a stone over their lifetime. They occur when different elements in the urine crystallize out, such as calcium. They tend to form a crystal that continues to grow in certain conditions. And with time, those stones can grow and can block the kidney or other painful symptoms.
We focus on modifying aspects of people’s lifestyles and diet in order to minimize their risk of forming stones. To prevent the formation of kidney stones, we recommend:
- staying well hydrated;
- drinking over two to three liters of fluid per day;
- having a low or reasonable amount of sodium diet;
- having not too much protein in one setting, whether it is fish, red meats or other sources of protein;
- sticking to a reasonable amount of calcium in your diet.
Kidney Stones Surgery
The primary treatment for kidney stones depends upon the size and location of the stone.
If stones that are four millimeters or less in size, we will try to allow it to pass spontaneously and manage the patient’s symptoms.
Kidney stones do not cause pain by themselves. They do it when they obstruct. That is why the presence of a kidney stone or its passing does not result in pain. A stone that obstructs can give you the worst pain imaginable.
The stone requires surgical intervention if it is larges than eight millimeters.
There three most commonly used treatments for kidney stones surgically. The first is ureteroscopic laser removal of the stone, which is a scope passing directly up the urinary tract. We remove the stone by using a laser to reduce it to dust, vacuum out the pieces, and leave that stent in.
Another option is shock wave lithotripsy, where we focus shock waves on the stone and reduce the stone into multiple small pieces, which can then pass spontaneously.
The third option for very large stones is called percutaneous nephrolithotomy. We go directly into the kidney through a hole that we make, which allows us to use the laser and other instrumentation to break the stone down and evacuate the pieces.
ESWL (Extracoporeal Shock Wave Lithotripsy)
The procedure involves the generation and transmission of pulses through the skin focused on the kidney stone. It then fragments, and its small pieces are passed in the urine.
ESWL’s major advantage is it’s a day case procedure under no anesthetic. It is very effective for certain types of stones and certain patient groups.
However, it’s not sufficient for all stones. There are some very large and hard stones, which are hard to break by lithotripsy.
In addition, some patients are not suitable for lithotripsy, particularly those with a high body mass index. In this case, the shockwaves are dissipated into the body before reaching the stone.
The major disadvantage of lithotripsy is that we can rarely analyze the stone fragments afterward because they pass out in the urine. At the same time, ureteroscopy enables us to take a stone fragment and sent it off for analysis.
Ureteroscopic Stone Removal
We can break down the word Ureteroscopy into two terms. One is ureter-, which is the tube that connects the kidney to the bladder. And -oscopy, which describes the medical term for examining a part of the body with a camera. To put it short, during a ureteroscopy physician uses a camera to scan the ureter.
We perform ureteroscopy to examine the ureter for a kidney stone in order to evaluate, treat, or remove it. We can also recommend the procedure for other reasons such as to evaluate the ureter, see if there is any obstruction, or look for tumors.
How to perform ureteroscopy? A urologist uses a ureteroscope, which is a small, flexible instrument. Its construction has advanced significantly over the last 40 years. This instrument is now flexible at the tip and can turn quite dramatically to evaluate any portion of the urinary tract effectively.
This procedure is typically performed under general anesthesia in an outpatient surgical setting. It’s minimally invasive, which means there are no incisions. A surgeon inserts cameras through the urethra into the bladder and up into the ureter.
What are the risks of the procedure? Any surgery under general anesthesia has the risks of an anesthetic. There are also other minor and rare risks, including damage to the bladder or ureter. Other risks include bleeding in the urine afterward and urinary tract infection. And as with any procedure, there might be some pain.
What are some of the benefits of ureteroscopy? Compared to extratropical shock wave lithotripsy, ureteroscopy can visualize the stone. And no matter the stone’s density, a laser can break up the stone into tiny pieces.
What are some of the risks in comparision to shock wave lithotripsy? Ureteroscopy is minimally invasive, while shock wave lithotripsy is often a non-invasive procedure. Each procedure has slight advantages and disadvantages and depends entirely on the patient.
Percutaneous Stone Extraction (percutaneous nephrolithotomy)
A surgeon performs a procedure through your skin into your kidney to treat and remove a kidney stone.
We recommend percutaneous nephrolithotomy for many reasons, usually to treat large or complex kidney stones.
The procedure offers a different access point into the kidney, allowing the surgeon to access stones that would be difficult to treat from other angles. Additionally, the surgeon can use much larger instruments and treat very large stones in a short time. The stone clearance rate with a PCNL is much higher than performed with extra corporal shockwave lithotripsy or ureteroscopy.
The procedure does come with slightly higher risk, including damage to the kidney and surrounding organs, but this risk is generally low and high volume centers.
The first thing that a surgeon does is looking at the CT scan preoperatively to examine the stone, the kidney, and the surrounding organs. Ideally, a surgeon should access into the kidney in a single calyx in order to treat all the stones. However, some stones are very complicated. There may be multiple stones or difficult to access locations that require more than one access point.
It’s essential to also map out, in addition to the stones, the surrounding organs such as the lung, liver, spleen, or bowel, to avoid injury to those when attempting to treat the kidney stone.
Next, in the operating room, the patient is put to sleep. Then we place a small catheter through the urethra up into the kidney. It allows him to map out exactly where the kidney is with the use of an x-ray.
Then we transfer a patient to his/her stomach. Then we begin by accessing the kidney exactly where we pick to go preoperatively.
Once we place a needle in the precise location, we dilate a tract and place a sheath to allow our instruments to go inside and outside the kidney without losing access. We then use tools to break the stone and remove it completely.
A surgeon examines the kidney very carefully to make sure there are no residual stones. Following the procedure, we usually place a urethral stent to allow the kidney to drain and heal from the procedure. A nephrostomy is required in rare cases, which is a small tube going from the kidney outside the back to draining urine.
Open Stone Surgery
Sometimes it is impossible to remove kidney stones by minimally invasive procedures, and open surgery is the only solution. Usually, a urologist will only treat kidney stones with open surgery when the stones become too large, irregularly shaped, cause uncontrollable bleeding, or pose a dangerous risk to the kidneys. Also, open surgery is occasionally used to treat severely obese patients.
To perform nephrolithotomy, the surgeon makes an incision through the patient’s flank, which is on the side between the last rib, the hip, and the kidney. A surgeon should isolate arteries in the kidneys from the surgical region because one mistake could result in severe bleeding. Once the surgeon removes the stone, a catheter is inserted into the kidney to drain urine so the kidney can heal.
After a person receives open surgery for kidney stones, they typically stay in the hospital for 6 to 9 days. In most cases, the patient can resume normal activities after 4 to 6 weeks of recuperation.
Pain, swelling, nausea, vomiting, and low-grade fever are common side effects of the surgery. Like any other type of invasive surgery, nephrolithotomy is dangerous and presents certain health risks that are non-existent or less common with other kidney stone treatments. For instance, there is a risk for severe bleeding, infection, and side effects due to anesthesia with open surgery. What’s worse, there is a high risk of permanent kidney damage, and worst of all, kidney failure.
People with blood disorders, systemic infections, or impaired kidney functioning should not have open surgery to treat their kidney stones.