SURGICAL INTERVENTIONS FOR URINARY STONES

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Dr K Muruganandham

SURGICAL INTERVENTIONS FOR URINARY STONES

Authored by Dr K Muruganandham, Head of Department & Senior Consultant – Urology and Renal Transplantation, Gleneagles Global Health City 

Kidney stones are deposits of calcium and other mineral salts. These lumps get deposited in the urinary tract and cause pain when they are stuck in your urinary tract and result in obstruction to the flow of urine. Stones that are small can come out by themselves without treatment but in certain situations surgery may be required to remove them. Kidney stones can be formed due to various factors like dehydration, increased intake of salt in diet, increased consumption of animal protein, increased blood levels of uric acid, obesity, Inflammatory bowel disease (IBD), Diabetes type 2 and kidney anomalies that increase calcium excretion in the urine.

Symptoms of kidney stones include severe backache either to the right or left depending on the side of the stone, frequent and painful urination and passing of blood in the urine. In rare cases, an infection can develop and cause fever.  If both the kidneys are blocked with stones, it can result in life threatening kidney failure. Kidney stones can develop at any age. So, if you suspect any of these symptoms you must see a Urologist for further evaluation and treatment.

Small stones can be managed medically with increased consumption of water and appropriate medications. Stones beyond a certain size may not come out by themselves and will necessitate some kind of a procedure. Most of the stones are being managed by minimally invasive techniques nowadays.  A few select stones can be managed by Shock Wave Lithotripsy. Open operation for stones has become almost obsolete.

The type of surgery or procedure depends on the size and location of the stone. Stones that are stuck in the ureter (the muscular tube which connects the kidney and the bladder) can be dealt with by a procedure called as URETERO-RENOSCOPY (URS). It involves the passage of an endoscope, either rigid or flexible, through the natural urinary passage under anaesthesia. With the help of this scope, the stone is reached and fragmented into small pieces with a laser. With this technique, stones in the ureter and stones inside the kidney upto a certain size, location and hardness can be safely treated.

Stones inside the kidney beyond a certain size and in some locations may not be amenable to the above-mentioned technique. For such stones, we employ a technique called as PCNL (Per-Cutaneous NephroLithotomy) wherein, a small hole or puncture is made in the back of the patient under anaesthesia. An endoscope is passed directly into the kidney and the stone is broken with a laser and retrieved as small fragments.

Stones in the urinary bladder are also treatable by purely endoscopic techniques. Laparoscopy is another minimally invasive technique used for stone surgery especially for large ureteric stones.