Normally offered to the patients with very small kidney stones e.g. 2 to 5 mm stone lying in the peripheral (Calyceal) region which are asymptomatic and at the same time the patient has easy access to medical help. This approach still recommends life style change, dietary habits and regular checkup.
As per the natural history of the kidney stones, once they slip in the ureter, in 70% of the cases they will pass out. (depending on the size of stone, site at the time of presentation and type of stone). This expulsion of stone can be made painless and enhanced by the use of drugs that relieve the spasm of the smooth muscles of the ureter, and dilate the lower part of the ureter and urethra and thus help in painless expulsion of the stone. For this modality of treatment,the selection of cases is important by an experienced Urologist. Various co-morbidities must be looked into before the patient is prescribed this treatment (e.g. Diabetes, infection, hypertension etc.)
It is a non-invasive method of kidney stone treatment, very often called ‘Laser’ by many patients. Well, it is not a laser but these are sound waves generated by various methods (depending on the machine). These are focussed on the kidney stone by X-Ray Localization or USG Localization, in order to break the stone. The success of this treatment depends on many factors e.g. Size, type and location of kidney/uretric stone. It should be offered as a treatment modality after considering many factors e.g. Infection status, time in hand and co-morbid diseases. It is an excellent modality of treatment in the hands of an experienced Urologist. Patients must be aware of certain facts and these are:-
- One might require multiple sittings of lithotripsy for kidney stone or ureteric stone.
- One may require a stent insertion or auxiliary process, at times, to achieve stone-free status.
- The treatment may have side-effects and complications which the patient must be aware of at the time of treatment.
Retrograde Intra Renal Surgery includes the use of a Flexible Ureteroscope, that can be passed into the kidney through the urethra, bladder and then the ureter. The kidney stone is either removed intact using a grasping device or fragmented or dusted using HOL-YAG LASER. By this method we can even remove small kidney stones of 3 or 5 mm. Normally, in these cases, an indwelling stent is inserted for a period of 7 days to 1 month.
In this procedure, a semi-rigid (endoscope) ureteroscope is passed under vision upto the stone in the ureter, and the stone is removed intact or by fragmentation with an energy source like LASER or LITHOCLAST. Normally these patients are put on an indwelling stent to avoid pain and the complication of passage of a small fragment or oedema caused secondary to ureteroscopy.
Percutaneous Nephrolithotomy(PCNL), as evident from the name involves a tract formed artificially from the skin upto the kidney’s Pelvic-Calyceal system which normally contains the kidney stone. This tract is maintained by a hollow tube through which the Endoscope is passed into the kidney and the kidney stone is fragmented with an energy source and removed in chips.
These are the latest variants of PCNL, in which the size of the tract has decreased significantly and thus recovery is faster, less painful and with lesser complications. These methods have literally replaced conventional PCNL at KUC. These are the latest method of kidney.
Laparoscopic Stone Removal is used in case of a very large kidney stone in the ureter or the pelvis or in cases where reconstruction of pelvicalyceal system is required along with stone removal.