When will You Need Surgery for Kidney Stones?

2018-12-03 / RG STONE HOSPITAL / Urinary / Kidney Stone

What are Kidney Stones?

These are hard deposits which occur due to excess of various combinations of minerals and chemicals in the body. The calcium-phosphate-oxalate combination can cause the deposits.

Kidney stone is a painful condition which can affect the urinary tract. As per statistics, every year 3 million people visit the health care centers complaining of the same. In most cases, the stones pass out of the body but there are serious cases which require medical intervention. Surgery is a possible treatment affair under some conditions.

Diagnosis :

• An investigation like a blood test is good enough to find out the presence of excessive uric acid or calcium in the body.
• A urine test is also a good way to find the presence of kidney stones in the body.
• Imaging procedures like simple X-ray or CT scan are used for the identification and detection of the kidney stones.
   

However, there are a few factors which play a decisive role in surgery of kidney stones.
 

• Time plays a major role :

If the stone does not pass and the time between 4-6 weeks is over, then danger bells go ringing. To avoid the development of other complications or infections, it is better to get the stones removed through surgery.

• Large stone :

If the stone is too large and cannot pass on its own, then the better option is to go under the surgery. Normally, the stone passes through the urine but the large stones are unable to flush out of the body on its own.

• Gets Stuck :

The stone may get stuck while passing through the urinary tract. Moreover, it is painful and if it gets stuck, then the pain worsens. So the best option is to consider a surgery.

• Development of other complications :

In more serious cases, the kidney stones can also promote the development of other infections in the urinary tract. Thus removal of the stone through surgery becomes an inevitable choice. Even medical practitioners recommend the surgical process for the removal of the stone.

• Damage of the kidney tissue :

The kidney stone has the potential to cause damage to the kidney tissue. It can cause bleeding also. Some people can witness streaks of blood in their urine while urinating and this is a clear indication that the surgical process is required.

These are some of the factors which clearly suggest surgery. The surgery required for the removal of the stones is not a major one. These are not life-threatening and delay in the surgery should not be observed because it may lead to the development of other infections in the body.

Moreover, technology has facilitated surgical procedures to a great extent. Surgeries which are successful to get rid of the kidney stones are:
 

Procedures :
 

• Extra corporeal Shock Wave Lithotripsy (ESWL) :

In case of small sized stones of less than 1.5 cm, this technique is used. The shock wave impulses (electromagnetic) from outside the body are given through a machine called ‘Lithotripter’ & focused onto the stone inside the body. The stone is broken into small pieces (1-2 mm) & dust (stone dust). The small broken pieces pass out in urine in next few days.

• PerCutaneous NephroLithotomy (PCNL) :

For stones over 1.5 cm in size, this technique is used. It is a keyhole surgery procedure in which 3 punctures are made in the kidney (0.5 mm) from the low back of the body under guidance of x-ray or ultrasound using a fine needle through which a guide wire is passed. Then gradually a tract is created. The stone is then fragmented (broken) into small pieces by laser or ultrasound energy. These small pieces are then removed from the kidney. Stent is left in place for few days so as to ensure free flow of urine. The patient becomes stone free immediately after the surgery. This is the most widely accepted technique. PCNL results in superior stone free rates and low retreatment rates than ESWL. Hospital stay of 2-3 days is required and patient resumes normal activities in a week.

• Ureterorenoscopy (URS) :

In this procedure, rigid or flexible ureterorenoscope (scope to see ureter and kidney) is inserted through the urinary passage (no incision) to visualize the stone. It is then converted into fine dust with holmium laser. At the end, a stent is placed, which is removed after few days. It can be done for stones uptil pelvi-ureteric junction.

• Retrograde Intrarenal Surgery (RIRS) :

Ureterorenoscopy using flexible ureteroscope is called Retrograde Intrarenal Surgery (RIRS). It can be easily used for stones anywhere in the tract. It is especially suited for patients where ESWL cannot be performed (bleeding disorders; obesity) or has failed. Its advantages include no incision on the body, short hospital stay & early recovery. However, the procedure is expensive as the equipment is costly, there is chance of the scope to break, and even doctors need special training to perform it.

• Stent :

It is a plastic tube with coils at both ends. It allows free urine flow from kidney to bladder. It is usually placed before ESWL (if > 1 cm) and after PCNL, ureteroscopy. Stenting (placing stent) is also indicated in patients in whom ESWL fails. Complications after stenting may include mild irritation, back pain and blood in urine for few days. The stent is removed within the period as decided by the doctor.

• Laparoscopic Stone Management :

This procedure involves performing steps of open surgery for stone removal through 3-4 ‘ports’ (“holes”) in abdomen. It is used when ESWL, PCNL and ureterorenoscopy fail or are deemed unsuitable, when the stone is inaccessible, in case of pelvic kidney stone resistant to fragmentation, multiple stones, abnormal kidney size or position, stone at a position where PCNL cannot work. Laparoscopic assisted PCNL is utilized in cases of renal stones in ectopic (misplaced) kidneys, structural kidney disorders (uretero-pelvijunctional obstruction) with associated stone disease.

Laparoscopic nephrectomy (kidney removal) has mostly replaced open surgery. Laparascopic ureterolithotomy (ureteric stone removal) is occasionally utilized in cases of stuck (lodged), large ureteral stones which are unable to be treated by endoscopy techniques (using instruments to view the interior of a hollow organ).

It often converts into an open surgery.
 

• Open Surgery :

Open surgery for stone removal is rarely used. Various studies have shown PCNL to be superior to open surgery. It is advised only in case of impacted (stucked) stones, infectious stones or recurrent (forming again & again) stones.
 

Conclusion :
 

It is thus very important to understand the depth of the issue so that the best remedial therapy can be opted for. Surgery is an inevitable decision under the above-mentioned factors. It should not be ignored and the practitioner will guide the patient better.