When you seek help for kidney stones, there are many possible treatments to relieve the discomfort and restore normal kidney function by surgically removing the stones. Fortunately, the field of medicine has come a long way, and we now have several effective techniques that can assist in removing kidney stones.
In this blog, we will cover the four most popular methods: Retrograde Intrarenal Surgery (RIRS), Extracorporeal Shock Wave Lithotripsy (ESWL), Percutaneous Nephrolithotomy (PCNL), and Laparoscopy or Open surgical techniques. Each technique has its own benefits, and is selected according to the size, position and nature of the stone and the general health of the patient.
Extracorporeal Shock Wave Lithotripsy (ESWL)
Extracorporeal Shock Wave Lithotripsy (ESWL) uses high-energy sound waves to break kidney stones into smaller pieces that can be passed through the urinary tract. The patient lays on a unique table as a machine emits shock waves toward a kidney stone during the procedure. This energy shatters the stone, and over time, pieces are expelled from urination.
Key Features of ESWL:
Least Invasive: Painless process involving no incisions or surgical intervention.
Rapid Recovery: Minimal discomfort is reported by most patients and they may resume their routine shortly after the procedure.
Best for Smaller Stones: ESWL is primarily suited for stones smaller than 2 centimeters in diameter and located in the kidney or upper ureter.
Considerations:
Although ESWL is a safe and effective technique overall, it actually shows variable success particularly based on composition of stone and in patients with an altered body habitus. It may take multiple sessions to completely fragment the stone.
RIRS – Retrograde Intrarenal Surgery
Retrograde Intrarenal Surgery (RIRS) is a minimally invasive method that allows the access of the kidney through the nature urinary tract with the help of the flexible ureteroscope. Surgeons use this technique to navigate through the urethra and bladder into the ureter and kidney where the stone is located. After the stone has been visualized, it is fragmented using a laser fiber, and fragments are either extracted or able to pass spontaneously.
Key Features of RIRS:
Minimally Invasive Procedure: The procedure is carried out through the natural way of urinary passage, thus there are no external cuts leading to lesser risk of infection and scarring.
Precision: A flexible ureteroscope allows for visualization of the stone area in high definition, which helps in targeting the stone and fragmentation.
Versatile: Another major advantage of RIRS is that it can access stones in virtually all locations of the kidney and ureter, including regions that are not amenable to treatment with ESWL.
Considerations:
RIRS has special advantages in the case of lower pole stones or in case of failure of ESWL. But it might not be suitable for very large stones and may require a higher degree of technical skill.
Percutaneous Nephrolithotomy (PCNL)
Percutaneous Nephrolithotomy (PCNL) is an operative approach that allows the removal of medullary and complex calculi in a minimally invasive manner. For PCNL, a small incision is made in the patient’s back to form a direct tract into the kidney. This is followed by placing the nephroscope into the tract allowing the surgeon to see the stone and remove it. Often, the stone is fragmented with ultrasonic or laser energy before the pieces are removed.
Key Features of PCNL:
The Intervention of Choice for larger Stones: PCNL is the procedure of choice for stones greater than 2 centimeters or for those too big to be handled with ESWL or RIRS.
Immediate Access: Since the procedure is percutaneous, a direct access to the kidney is provided, which enables the urologist to remove all stone in one session, rather than multiple sessions.
State-of-the-art Technology: The use of sophisticated imaging modalities and specialty rigging techniques allows for increased accuracy and safety of the procedure.
Considerations:
Indeed, even though PCNL is more invasive than ESWL or RIRS, it has a high stone clearance rate. Recovery typically takes longer than with noninvasive techniques, and there is small risk of bleeding or infection.
Laparoscopic or Open Surgery
And sometimes kidney stones accompany anatomical defects or other minimally invasive techniques failed to resolve this issue, laparoscopic or open surgery may be needed. Using these types of surgery, incisions are made, either small (laparoscopic) or larger (open surgery) to access the kidney directly and remove the stone.
Features of Laparoscopic/Open Surgery:
A Missed Stone Can be Removed By These Procedures: This prosedure leads to direct removal of stones from the kidneys including embedded stones and large stones.
Anatomical Corrections: Surgery can also correct underlying anatomical abnormalities—like strictures (abnormally narrow sections of the urinary tract) or malformations—that can lead to stone formation.
Individualized Technique: The surgical technique is designed according to-mchin specifications to provide the optimal results for the patient.
Considerations:
During such cases where surgical methods are prohibited, it is preferable. These approaches are effective but are also associated with longer restorative periods, more postoperative pain, and an increased risk of complications compared with minimally invasive strategies.
Dr. Deepanshu Gupta | Best Urologist in Gurgaon
Sorting through the treatment options for kidney stones can be tough but with the right doctor on your team, patients can find relief and get back to their lives.
Depending on the size, position, and composition of the stone, each kidney stone removal method from RIRS, to ESWL, PCNL, to surgery, has its own set of pros and cons.
This niche of advanced treatment modalities has opened new doors for patients, with a leading expert in stone clearance in the form of Dr. Deepanshu Gupta.
An accomplished urologist, Dr. Deepanshu Gupta has a deep commitment to patient care and a successful record of procedures, all while incorporating state-of-the-art techniques and compassionate treatment. His specialization guarantees that every patient receives individualized attention, with a focus on not just extracting the stone, but also guarding against future development.
If you are dealing with a history of recurrent kidney stones or need treatment for a complicated, standalone incident, Dr. Deepanshu Gupta works to ensure your experience with kidney stone management is not only efficient, but also safe and innovative.
Book a consultation and take an informed step in the direction of a pain-free future.