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RG Marathon Championship 2022

What Surgical Options can be Used for Kidney Stone Treatment?

What Surgical Options can be Used for Kidney Stone Treatment

Kidney Stones are those hard deposits that are made up of minerals such as calcium or waste products such as uric acid. They are initially small in size, but they can grow bigger as more minerals stick to them or ignored for a long time.

While some kidney stones often pass on their own without treatment through urine, however, other stones that are bigger in size are generally painful and get stuck in the urinary tract leading to a direct need to remove the stone with the help of surgery.

One would have to undergo surgical methods if the following situations are created:

  • The stone is bigger in size and is unable to get out of the body through its routine urinary tract
  • There is severe pain in the side and back of the body just below the ribs. It is a pain that radiates to the lower abdomen and groin area.
  • The stone is blocking the flow of urine out of your kidney causing a lot of discomforts.
  • One has had many urinary tract infections in the past because of the stone.

Types of Kidney Stone Procedures and Surgeries :

There are various surgical methods for treating the kidney stones depending on the kind of kidney stone, the severity of the problem and the modality of the treatment that is compatible to the patient’s body considering his or her medical record.

The four primary surgical methods for the treatment of kidney stones are :

  1. Shock wave lithotripsy
  2. Ureteroscopy
  3. Percutaneous nephrolithotomy or percutaneous nephrolithotripsy
  4. Open surgery
  • Shock Wave Lithotripsy: 

Shock Wave Lithotripsy is the most common kidney stone treatment amongst patients. It works best for those having small or medium stones. The best feature of this surgery is that it is noninvasive, meaning that no cuts are made in the skin of the body and high-energy shock waves are used to break the stones inside the kidney.

In this surgical procedure, shock waves from outside the body are targeted at the kidney stone leading the stones to fragment into small pieces. The stones thus break into tiny pieces. If large pieces still remain then another treatment can be performed. Stones that are smaller than 2 cm in diameter are the best size for SWL. The treatment might not be effective enough for those having larger stones.

  • Ureteroscopy:

This procedure treats stones in the kidneys and ureters where the doctor uses a thin, flexible scope to find and remove stones. No cuts are made in your skin in this surgical procedure as well. 
This procedure involves the passage of a small telescope, called a ureteroscope, through the urethra and bladder which goes up the ureter to the point where the stone is located. This is the point where the surgery takes place. Ureteroscopy is generally performed under general anaesthesia, and the procedure usually lasts from one to three hours.

If the stone is small, it can be easily removed from the ureter. However, if the stone is large, or if the diameter of the ureter is narrow, the stone would have to be fragmented, which is then usually done with a laser. Once the stone is broken into tiny pieces, these pieces are removed.

Ureteroscopy would not be a good and effective treatment for patients with large stones because of the impracticability and impossibility and for patients with a history of urinary tract reconstruction which does not allow the passage of a ureteroscope in the first place.

  • Percutaneous Nephrolithotomy or Percutaneous Nephrolithotripsy

This procedure means treating the kidney stones for patients having large or irregular shaped kidney stones or people with infections or stones that have not been broken up enough by SWL or those who have not been treated by the above two treatment modalities. This surgical procedure specifically caters to people having stones that are bigger than 2 cm (the size of a marble) require this procedure.

Both procedures involve entering the kidney through a small incision in the back. Once the surgeon reaches to the kidney, a nephroscope (a miniature fiberoptic camera) and other small instruments are threaded in through the hole of the body.

lf the stone is removed through the medium of the tube, it is called nephrolithotomy, however, if the stone is broken up and then removed, it is called nephrolithotripsy. High-frequency sound waves are used to break up the stone, and then vacuum up the dust using a suction machine.

  • Open Surgery:

Open surgery is a rare option for surgery that is done for kidney stones. This surgical procedure is apt for large stones or for those stones that cannot be removed or crushed with other treatments. Surgery would be helpful in cases where:

  • Stones are stuck in the ureter.
  • One is facing severe pain
  • The stone is blocking the passage of urine
  • One is bleeding or having an infection

The stone will be removed through the opening where a stent is placed in the ureter to help urine drain. One would have to spend more time in terms of days in the hospital and overall, it will take about a time period of 4 to 6 weeks to fully heal after the open surgery.

Thus, these are some of the surgery options that are available for people having kidney stones depending on the intensity of the kidney stone problem. However, what is important to know is to first consult a doctor and understand the whole situation of the problem before taking a decision weighing the pros and cons of the treatment modality that one is choosing for oneself.

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By RG Hospital

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