Laser Stone Surgery

Urinary stone or renal stone deposition is one of the most common and most painful disorders of the urinary tract. A urinary stone is a hard crystalline mineral material that forms within the kidney or urinary tract. The most common type of stone contains calcium in combination with either oxalate or phosphate. A less common type of stone is caused by infection in the urinary tract, and are referred to as struvite or infection stone. Much less common are the uric acid stone and the rare cystine stone.

Causes

Urinary Stones usually arise because of the breakdown of a delicate balance. The kidneys must conserve water, but they must excrete materials that have a low solubility. These two opposing requirements must be balanced during adaptation to diet, climate, and activity. The problem is mitigated to some extent by the fact that urine contains substances that inhibit crystallization of calcium salts and others that bind calcium in soluble complexes. These protective mechanisms are less than perfect. When the urine becomes supersaturated with insoluble materials, because excretion rates are excessive and/or because water conservation is extreme, crystals form and may grow and aggregate to form a stone.

Symptoms

The first symptom of a kidney stone is extreme pain. The pain often begins suddenly when a stone moves in the urinary tract, causing irritation or blockage. Typically, a person feels a sharp, cramping pain the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur with this pain. Later, the pain may spread to the groin.

If the stone is too large to pass easily, the pain continues as the muscles in the wall of the tiny ureter try to squeeze the stone along into the bladder. As a stone grows or moves, blood may be found in the urine. As the stone moves down the ureter closer to the bladder, a person may feel the need to urinate more often or feel a burning sensation during urination.

If fever and chills accompany any of these symptoms, an infection may be present. In this case, a doctor should be contacted immediately.

Diagnoses

The urologist will order laboratory tests, including urine and blood tests. He or she will also ask about the patient’s medical history, occupation and dietary habits. If a stone has been removed or if the patient has passed a stone and saved it the lab can analyse the stone to determine its composition.

X-ray is the chief method used to diagnose kidney stones. Ultrasound can also be used to detect stones and urinary obstruction.

Your doctor might ask you to undertake a battery of tests to confirm that the stone disease is not the result of any primary disease.

Treatment

Conservative Treatment: In asymptomatic patients a wait-and-see course may be recommended by the doctor. Many stones will become symptomatic and produce acute renal colic while travelling down the ureter sometime in the future. The stones may enlarge and then become more problematic and difficult to treat.

Symptomatic Treatment: The severe pain of renal colic needs to be controlled by potent pain killers. Don’t expect an aspirin to do the trick. Get yourself to a doctor or an emergency room. Also, the pain may be caused by some other problem needing immediate attention.

ESWL: Extracorporeal shock wave lithotripsy (ESWL) is a technique of shattering a stone with a shock wave produced outside the human body. There are several methods for producing an acoustical or ultrasonic “big bang” which is then focused from outside into the kidney and the kidney stone.

Surgical Treatment: Surgery may be needed to remove a renal stone if it does not pass after a reasonable period of time, if the stone is growing and blocking the flow of urine and the other techniques are not a success. Endoscopic surgery is a minimally invasive surgery performed using endoscope a specialized surgical instrument which is a thin, long, flexible tube with a camera and light attached to it that enables the surgeon to view inside the body. Various endoscopic surgeries performed to remove the renal stones include ureteroscopic and percutaneous endoscopic surgeries.

Ureteroscopic Surgeries

The procedure is performed by inserting a special telescopic instrument called ureteroscope. Ureteroscope is long and thin compared to cytoscope that can be used to view and perform surgeries beyond the bladder into ureters. Ureteroscope will be inserted through the urethra, into the bladder, and up through the ureter. Once the stone is located within the ureter, the surgeon removes the stone with the tiny basket attached to a thin wire which is inserted through the other channel in ureteroscope. Surgeon may also use laser energy to remove or break the stones located in the ureter or kidney that are up to 3 cm in diameter. This is called laser lithotripsy where pulses of intense laser light can be used to fragment the stone into smaller pieces which are then flushed out through the urinary passage. A small tube or stent may be left in the ureter for a few days to help urine flow. The holmium laser is the most effective laser for the treatment of urinary stones.

• Advantages

  • Short hospital stay
  • More effective in removing hard stones
  • Removes stones from any location in ureter or kidney
  • Effective in removing stones of all compositions
  • Quick recovery and patients resume daily activities in one or two days
  • Possible complications following laser lithotripsy include, bleeding, infection, and tissue scarring.
• Percutaneous Endoscopic Surgery

  Percutaneous endoscopic surgery or percutaneous nephrolithotomy (PCNL) is a keyhole surgery for removal of kidney stones. During the procedure a tiny incision is made at the back through which a guided wire is passed into the kidney and a tunnel is created directly into the kidney. The procedure is performed under X-ray guidance. Using an instrument called a nephroscope the surgeon locates and removes the stone. Larger stones will be fragmented using ultrasonic, electrohydraulic, or laser treatment and the fragments will be removed. After the procedure a nephrostomy tube is left in the kidney for drainage of urine for one or two days.

  Advantages

  • Minimal incision
  • Direct visualization and removal of stones
  • Short hospital stay
  • Clearance of stones in over 90 to 95% cases in single session

  Some risks and complications associated with PCNL are mild bleeding, infection, perforation, injury to nearby organs and urine leakage.