Kidney Stones Treatment In Agra

How are kidney stones diagnosed?

Most urinary stones are formed in the kidney and may either remain inside the kidney or travel through the ureter, a tube connecting the kidney to the bladder. Kidney stones are visible on ultrasonography and often on x-ray. Many times, stones are silent and are picked up on ultrasound or x-ray done during general health check-ups or for any other condition. Some tiny stones pass out of the body unnoticed. Commonly, one complains of pain in the flank often severe compelling one to visit a hospital emergency. At other times, one may see blood in urine or have a burning sensation while passing urine. Sometimes, one may have a fever which is indicative of infection. Occasionally, the only symptom is prolonged loss of appetite and nausea which may indicate deterioration of kidney function. Ultrasound and X-ray provide valuable information on the size and location of kidney stones. Blood and urine tests help detect abnormalities that might promote stone formation.

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Sometimes, information on ultrasound and X-ray is not sufficient. Doctors may decide to scan the urinary system using advanced tests, such as computed tomography (CT scan) or intravenous urography (IVU). The results of all these tests help plan appropriate treatment.

What are the treatment options for kidney stones?

Stone disease is a recurrent problem; in other words, these tend to form again even after successful removal. Therefore, dietary changes, and sometimes, medical treatment are required to prevent recurrence. Conservative measures include:

Hydration – drinking plenty of liquids not only helps small stones to flush out, but also prevents recurrence.

Medication – Your doctor may prescribe medication depending on the situation. For example, for a painful stone stuck in the ureter, the doctor will prescribe medication to control pain and to facilitate flushing out of the stone (same medications are prescribed for men with prostate problems). In other instances, you may need antibiotics in case there is an infection or occasionally medication to dissolve specific types of stone (e.g. uric acid). Patients who are forming stones very frequently are often prescribed specific preventive medication.

Diet – Your doctor will advise some long-term changes in your diet which would help decrease recurrence. For example, you will be advised to curb salt and sugar in your diet and to take adequate amounts of milk products with food. Some specific changes may be advised depending on the type of stone.

When is surgery needed to remove kidney stone?

Very small stones in the kidney (generally speaking less than 5mm) that do not cause any pain or infection may be left alone for observation. However, most of the other stones would commonly need to be removed. Some such circumstances are as under:

1. Bigger stone in the kidney even if it is not causing pain or infection
2. Stone stuck in the ureter for a long time causing severe symptoms; nevertheless, many such smaller stones may be successfully expelled with medication and hydration. Your doctor will decide the length for which wait and watch may be followed.
3. Any stone causing infection or constant bleeding
4. Stone causing blockage in flow of urine from kidney causing back pressure changes which can potentially damage the kidney function
5. Stones getting bigger on follow-up scan

Up until the late 1970s open surgery was the predominant mode of surgical treatment requiring big incisions and prolonged recovery ranging 4-6 weeks. Over the last several decades technology has greatly advanced and such surgeries are rarely, if ever, required. Most small stones can be managed with no-incision minimally invasive procedures at a daycare. Even large stones can be tackled with keyhole surgeries, whether through a hole in the kidney or by laparoscopy.

What are different surgical treatments for kidney stones?

1. Extracorporeal shock-wave lithotripsy (ESWL)

This is one of the most commonly performed procedures for small stones in the kidney or ureter. It is done under sedation and most of the time you will be discharged on the same day. It does not require any instrumentation or cut on the body. Shock waves are produced outside the body using electromagnetic waves in highly specialized equipment. These are targeted on the stone using X-ray or ultrasound guidance and travel through the skin and tissues and hit the stone. The stone is broken into small fragments which then pass out through urine over some time.

2. ureterorenoscopy (URS)

This is the most commonly performed endoscopic procedure for urinary stones. It is done under full anesthesia, nevertheless most of the time you will be discharged on the same day. It is an endoscopic procedure not requiring any cut on the body. this involves a fine caliber instrument that is passed through natural urine passage up to the stone, the stone is broken into small pieces using laser, ultrasonic, or ballistic energy source, and the resulting fragments may be either removed using specialized baskets or left to pass out later. Quite often a small tube (called a stent) is placed along the ureter for a few days to help flow urine from the kidney. The stent must be removed by a small endoscopic procedure once its work is done (mostly in 10-21 days).

Most ureteric stones can be managed with this technique. Most small to moderate-size kidney stones (typically smaller than 2.5cm, or even larger if soft) may also be tackled with this technique; however, it requires a more advanced and delicate instrument called a flexible ureterorenoscope (either fiber-optic or digital) and a laser energy to pulverize the stone.

3. Percutaneous neohrostolithotomy (PCNL)

This is a major surgery done through a small cut (most often one, sometimes more) on the back in the kidney region. A passage (tunnel) is created from the skin into the kidney under ultrasound/x-ray guidance, the stone is located through a specialized instrument called a nephroscope, broken into small fragments using an ultrasonic, ballistic, or laser probe, and fragments are removed at the same time.

After this operation, the patient usually has to remain in the hospital for a few days (most commonly 2-3 days). Often the doctor will keep a tube (nephrostomy) coming out from the kidney for drainage which will be removed before discharge. Sometimes, an internal stent (similar to ureterorenoscopy) is also kept inside for unobstructed urine passage into the bladder.

This is the procedure of choice for very large stones in the kidney or those which are not amenable to ESWL or URS due to location.

4. Laparoscopic pyelolithotomy –

This is a major surgery, a type of keyhole surgery done through 3-5 small cuts on the side or front of your tummy. This is performed in rare circumstances when PCNL is deemed inappropriate, particularly in case of persistent infection, or when the stone is placed just outside the kidney and a hole in the kidney can be avoided.

5. Laparoscopic ureterolithotomy –

This is a major surgery, a type of keyhole surgery done through 3-4 small cuts on the side or front of your tummy. This is performed when URS is deemed inappropriate, particularly in case of persistent infection or very large stone.