Kidney stones usually develop as a result of the accumulation of minerals and salts that kidneys filter. Most people experience extreme discomfort when the stone is being passed through the urinary tract. Nowadays, medicine has an array of techniques that aid painless non-invasive or minimally invasive kidney stones removal. In this article we discuss the various techniques along with their procedures, pros, and other important factors.
Understanding Kidney Stones
As previously discussed, kidney stones result due to high levels of calcium, oxalates, and uric acid in urine. In turn, they crystallize. Over time, they become stones of various sizes. Some can be passed out without any symptoms, but others lead to severe excruciating pain, urinary blockage, hematuria, or other complications.
Non-Invasive and Minimally Invasive Removal Techniques
For kidney stones, open surgery is never the first course of action. These days, medicine has developed many techniques that are far less invasive. Each treatment option works uniquely depending on the patient’s condition along with the size, location, and composition of the stone.
1. Retrograde Intrarenal Surgery (RIRS)
RIRS is one of the most sophisticated procedures for treating kidney stones, particularly those situated in the inaccessible regions of the kidney, as it is one of the least invasive procedures. It entails the use of a ureteroscope, which is a flexible fiber optic scope, which is advanced beyond the urethra to the bladder, then to the ureter and finally to the kidney. A stone usually has to be engaged before a laser, which is holmium in most cases, blows it into tiny pieces. The resultant fragments may either be retrieved or obliterated in the urine stream.
Benefits:
- Painless and Scar-Free: Since RIRS is performed through natural urinary tracts, there are no external incisions or sutures involved.
- Ideal for Complex Cases: It’s particularly effective for small to medium-sized stones located in the lower calyx or difficult angles of the kidney that may not be reachable by other techniques.
- Short Recovery Time: RIRS patients enjoy returning to their homes hours or a day after procedure and experience expedited recovery.
- Safe for High-Risk Patients: Its minimal invasiveness makes it a favorable option for elderly or medically complex patients who may not withstand open or percutaneous surgery.
Notes:
- An external stent is put in place after the procedure to ensure the ureter remains open and to minimize post-operative edema. This is taken out within a few days.
- Post-operative symptoms such as mild dysuria and hematuria are self-limiting and resolve in a few days.
- RIRS is highly favored among procedures for patients seeking effortless, safe, and efficient methods of stone extraction, particularly when the stones are situated deep inside the kidney.
2. Extracorporeal Shock Wave Lithotripsy (ESWL)
Technique: As a non-invasive procedure, ESWL utilizes the application of high-energy shock waves to break kidney stones into smaller pieces. The shock waves are generated outside of the body and are directed precisely at the stone’s location using imaging techniques. The fragments generated are small enough to be easily passed through the urinary tract.
Advantages:
- Non-invasive: No surgical incisions are required.
- Outpatient: Often performed as an outpatient procedure, permitting patients to go home the same day.
- Reduced Downtime: Most people can return to their normal routine in a matter of days.
Take Note:
- ESWL is the most effective on stones smaller than 2 cm in diameter.
- Inappropriate for pregnant woman or people with a risk of bleeding.
- Some patients may experience pain during the stone fragment passing process.
3. Ureteroscopy With Laser Lithotripsy
This surgery is performed with the aid of a thin, flexible ureteroscopy that is passed through the urethra, bladder, and into the ureter or kidney. After the stone is located, a laser fiber can be used to break the stone into smaller pieces that can either be removed or allowed to be passed.
Benefits:
- Direct Result: allows the urologist to see the stone and take the necessary action to deal with it pre-emptively.
- High Success Rate: It is effective on stones located in the kidney and ureter.
- Short Hospital Stay: Generally done on an outpatient basis with little to no need for admission.
Considerations:
- Intraoperative steroid treatment. To facilitate urine outflow and reduce inflammatory changes, a stent may be placed.
- Unpleasant sensations and mild blood urine are likely, but not for long.
4. Percutaneous Nephrolithotomy (PCNL)
PCNL is often recommended for large or more complex kidney stones. It involves the opening of the back to allow for the insertion of a nephroscope into the kidney through small incisions.
The stone is either fragmented using ultrasound or laser energy and subsequently removed.
Benefits:
- Effective for Large Stones: Very helpful for stones larger than 2 centimeters.
- High Clearance Rates: There is a good chance of removing one or many large stones successfully.
Considerations:
- General anaesthesia is a requirement.
- Most often, the period of hospitalization is one to two days.
- Recovery period is marginally longer than that of ESWL and ureteroscopy.
5. Medical Expulsion Therapy (MET)
Procedure: For small stones, especially those located at the bottom part of the ureter, medication can be prescribed to relax the ureter muscles, assisting with the stone’s passage.
This purpose is often filled by alpha blockers like tamsulosin.
Advantages:
- Non-Invasive: Drug therapy is the only requirement with no surgical intervention.
- Convenient: Provided through outpatient services along with regular monitoring appointments.
Considerations
- Suitable best for stones smaller than 10 millimeters.
- Not all patients are likely to respond; some will end up requiring other treatment methods.
Choosing the Right Treatment
The suitable treatment modality for kidney stones is influenced by a number of factors:
- Stone Size and Location: These are usually determined by the size of the stones. Smaller stones located within ureters are likely to be treated using MET techniques or ureteroscopy, while larger stones situated in the kidney might require ESWL or PCNL.
- Composition: Certain types of stones have a better chance of responding to treatment than others.
- Patient Health: Pre-existing conditions like pregnancy, disorders involving bleeding, and other factors can dictate the course of treatment.
- Patient Preference: Specific treatment routes depend on the need and desired lifestyle of the patient.
A urologist’s advice is key when determining the most effective treatment plan so as to tailor the interventional approach needed to optimal individual needs.
Preventing Kidney Stones
After one has received treatment, preventive steps should be taken to avoid reoccurrence:
- Hydration: Sustain the intake of fluids to dilute urine and stone formation.
- Dietary Adjustments: Reduce the level of sodium, animal protein, and oxalate containing foods.
- Regular Monitoring: Periodic medical check-ups and imaging studies to monitor the state of the kidneys.
- Medications: There are occasions when medication may be necessary for the prevention of certain types of stones.
Expert Care with Dr. Deepanshu Gupta
For kidney stone specialists in Gurgaon/Delhi NCR, Dr. Deepanshu Gupta is one of the most renowned urologists. Specialized in advanced urological surgery, Dr. Gupta has performed over 9,500 endoscopic surgeries and 12 years of surgical experience. His peers and patients consider him a reputable urologist in the region arising from his exemplary care and affordable prices for complex procedures like laser kidney stone removal.