Non-Surgical Treatment for Urinary Stones at World's Best Hospitals in India
Kidney stones are also known as calculi (plural), or calculus (singular). When it is in the kidney, it is a renal calculus. The tube draining the kidney to the bladder is the ureter, and a stone in the ureter is a ureteral calculus. It is estimated that 20% of us will have a kidney stone in our lifetime. Of those who get a stone, 50% will recur. Passing a stone is usually very painful. However, many patients can pass a stone with only a "muscle ache" sensation in the back, and they may not be aware the pain was from a stone until it "pops out."
How are kidney stones diagnosed?
When a urinary stone is suspected, an immediate evaluation is required. Blood is obtained to check on overall kidney function as well as to exclude signs of infection throughout the body. Urine is sent for a urinalysis and culture, also to examine for infection. A simple X-ray of the abdomen is sometimes enough to pinpoint a calcification in the area of the kidneys or ureters, thus identifying a likely obstructing stone. However it is sometimes difficult to determine if the calcification is within the urinary tract and also some stones are not radiopaque. Historically, an intravenous pyelogram (IVP) was done, but today computed tomography (CT) is the gold standard for stone diagnosis as it is very sensitive and can detect almost all types of urinary stones.
Extracorporeal shock wave lithotripsy (ESWL) is the most frequently used procedure for the treatment of kidney stones. In ESWL, shock waves that are created outside the body travel through the skin and body tissues until they hit the denser stones. The stones break down into small particles and are easily passed through the urinary tract in the urine.
Several types of ESWL devices exist. Most devices use either x-rays or ultrasound to help the surgeon pinpoint the stone during treatment. For most types of ESWL procedures, anesthesia is needed.
Percutaneous nephrolithotomy (PNL):
PNL is the treatment of choice for large stones located within the kidney that cannot be effectively treated with either SWL or URS. General anesthesia is usually required to perform a PNL. The main advantage of this approach compared to traditional open surgery is that only a small incision (about one centimeter) is required in the flank. The urologist then places a guide wire through the incision. The wire is inserted into the kidney under radiographic guidance and directed down the ureter. A passage is then created around the wire using dilators to provide access into the kidney.
An instrument called a nephroscope is then passed into the kidney to visualize the stone. Fragmentation can then be done using an ultrasonic probe or a laser. Because the tract allows passage of larger instruments, your urologist can suction out or grasp the stone fragments as they are produced. This results in a higher clearance of stone fragments than with SWL or URS.
Ureteroscopic Lithotrispy with Holmium Laser
Holmium Laser lithotripsy is the breaking of urinary stone using the Holmium laser. The wavelength is ideal for treating stones. The Holmium laser energy may be absorbed by the stone creating cracks within the stone. This laser energy is sufficient to break even the hardest stone.
The Holmium laser energy is delivered via thin fibers with various diameters to suit telescopes of different sizes. These telescopes may be rigid, metal telescopes or flexible fibreoptic type. This thin telescope called a ureteroscope is passed gently and skillfully through the natural urinary passage from the penis up the bladder into the ureter where the stone is. This procedure is called ureteroscopy. The Holmium laser fiber can be placed in contact with the stone or adjacent to it. Short Holmium laser pulses create a shockwave that causes fragmentation of the stone. Smaller stones can be fragmented directly, whereas with larger ones, holes are punched in the center, after which the edges are chiseled away with the Holmium laser. Finally, the residual fragments can be flushed out.