There are certain cases of kidney stones that would need surgery, although most stones pass on their own. The stones that are lodged in the ureters ( the tubes that carry urine from kidneys to the bladder), large or very painful stones present in the kidney, stones that are causing obstruction of urine flow, or stones that result in bleeding or infection. Some surgeries performed on kidney stones involve minimally invasive techniques and do not require a stay at the hospital either. Since the goal of this surgery is to treat all stones once and for all, there would be no recurrence. But certain cases of kidney stones require more than one surgery to reduce and clear the stones.
Laser treatment for Stones
When kidney stones are not too big, laser treatment is given in order to break down the stones into smaller pieces which can be either removed by the doctor or will pass out of the body along with urine. This procedure is known by the name laser lithotripsy, the procedure makes use of a ureteroscopy inserted into the urinary tract, the laser breaks down the kidney stones.
There are a few tests recommended before the procedure of lithotripsy. They are a physical exam, blood and urine tests, Imaging to locate the approximate position of the stone, chest x-ray, ECG that would give the electrical activity of the heart, kidney stone analysis.
The procedure for laser treatment takes an hour, done on general anaesthesia after which a ureteroscope is inserted into the urinary tract, where the doctor can view the stones and collect them into a basket. A temporary stent is placed in the ureter which helps to keep the ureter open, helps in easy urine flow and also the stones to pass out along with urine.
The post-procedure care would include pain medications, antibiotics to decrease the risk of infections and finally, an x-ray to determine the probability of some more stones that could have remained even after the procedure.
The time for recovery is usually 1-2 weeks, with some tiredness and discomfort, along with some lifestyle changes to be followed regarding hygiene, washing hands regularly or wearing masks, and call the doctor in case you have acute pain, inability to urinate, excessive bleeding, an infection, fever or chills, nausea or vomiting.
Laser lithotripsy is opted when the stone is too large to be removed by non-surgical treatments, the stones are irregular in shape or might have caused some bleeding in the process thus causing damage to the neighbouring tissues.
Shock Wave Lithotripsy is a painless procedure using shock waves in order to break kidney stone into pieces and then move through the urinary tract and finally come out of the body. The stones in the gall bladder also disintegrated using the same shock wave lithotripsy. There were not many side effects except that some had cutaneous petechiae, while others had an episode of colic, mild pancreatitis and such.
Shock wave lithotripsy, when combined with medications for dissolving stones, has been a safe and effective treatment for some patients with gallbladder calculi. With one single treatment given to patients, it was found that morbidity was low with short hospital stays, over 70% of the patients were free of stones at the end of 3 months, and a little over 20% of them had small asymptomatic fragments that could pass easily, while about 1% of them needed surgical removal of the stone.
Shock wave lithotripsy is now a chosen procedure for removal of kidney stones present in the upper part of the ureter or kidney, for small stones less than 2cm in diameter. A word of caution is that pregnant women, people with severe infections, obese people or ones with bleeding disorders, or abnormal functioning of kidneys will not be eligible for this procedure.
The methods of treatment in shock wave lithotripsy are- the body is positioned in such a way against a soft cushion in order to target the shock waves to the stone, or shock waves are sent in huge numbers into a tub of water in which the patient is placed. The procedure may need a local or may be done in general anaesthesia in order to comfort the patient. The time taken is just a few hours after which the patient is sent home. The time for recovery is a few days. In case the stones cannot be broken into small pieces, a stent is installed in the ureter to allow easy passage of urine and stones.
Percutaneous nephrolithotomy
This is the method for the removal of kidney stones when the stones have not yet moved through the urinary tract or large stones that are 2cm or more, and this is by far the best treatment for the removal of stones in the kidney. A small incision is made on the back through which a thin tube with a camera known as the nephoscopy is sent in order to locate the position of the stones. The stones would be broken by the surgeon using the surgical instruments. A tube may be left in the kidney to allow the drainage of urine out of the body while you heal from surgery. The patient can go home after the surgery, and the time of recuperation would be 2 to 4 weeks.
Cystoscopy/Ureteroscopy
This method of removal of kidney stones is done when the stones block the ureters, in which case a surgeon would do a ureteroscopy examination to locate the stone, after which he conducts the surgery to break the stones. He could use a cystoscope if the stone is located in the urinary bladder and continue the process of removal of kidney stones into fragments which can be easily removed. In the case of larger stones, a stent is inserted for easy exit of the stones during urination. Since this technique requires no incision, it is done as an outpatient procedure, allowing you to go home the same day.
Robotic-Assisted Kidney Stone Removal
Robotic-assisted surgery is a laparoscopic surgery which involves high resolution, three-dimensional view of small areas such as the ureters, hence providing surgeons a wider range of motion and the ability to make more precise incisions and less scarring too. The time of healing is also short, meaning short stays at the hospital.
Robotic-assisted kidney stone surgery is usually performed on people who weren’t born with a kidney drainage problem known as ureteropelvic junction obstruction. This obstruction also can be solved along with the removal of kidney stones. Only in rare occasions, robotic- assisted surgery would be recommended for patients whose kidney stones could not be removed by other surgical methods.
Text Credits: https://nyulangone.org/conditions/kidney-stones-in-adults/types
