TREATMENT OPTIONS

There are two ways by which you may be managed by your urologist.

A. Medical management:

For stones which are within the kidney and which are less than 10mm, the urologist will advise you to drink plenty of fluids and probably give you some medications which might help prevent stone formation. .Stones bigger than 10mm might need some form of surgical intervention.

For stones which are inside the ureter, the urologist will give you some pain killer medications and advise plenty of fluid intake if the stones are less than 10mm. Stones bigger than 10mm might need some form of surgical intervention.

B.Definitive management:

ESWL (EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY):

In this procedure, stones which are upto1.5mm inside the kidney or in the upper ureter can be fragmented. This is usually done as a day care procedure wherein you can get discharged in the evening after undergoing the procedure in the morning. You will be subjected to shock waves emanating from a machine that will break the stones. No anaesthesia is required. The main disadvantage of this procedure is that not all stones can be fragmented with this procedure and even if the stones do fragment well, there may be a delay in passage of the fragments (sometimes upto 6 weeks). Complications are that you might get pain till all fragments are passed in the urine. If the fragments don’t pass out,you will need other procedures to remove the stones.

PCNL (PERCUTANEOUS NEPHROLITHOTOMY):

Here, stones within the kidney are removed by making a small key hole in your back. The stones are removed by a rigid straight instrument called the nephroscope and you can go home in 3 days and return back to your normal activities in a matter of a couple of days. Complications are bleeding which may require blood transfusion and sometimes a procedure called renal angioembolization (a coil is placed in the blood vessel that has ruptured and has led to bleeding) may be required.

LASER KIDNEY STONE TREATMENT (or) RIRS (RETROGRADE INTRARENAL SURGERY OR FLEXIBLE URETEROSCOPY):

In this method, stones are removed by passing a flexible tube through the normal urinary passage. Stones within the kidney are fragmented using laser and removed. Stones of upto 3.5cm can be removed. Only a single day’s hospital stay is required. There are practically no chances of bleeding in contrast to PCNL and you can return to your routine activity the next day. However, the procedure is a bit expensive. This procedure is also a less morbid one than PCNL.

URS (SEMIRIGID URETEROSCOPY):

Here, stones within the ureter are removed by passing a straight tube via the natural urinary passage. Only a single day’s hospital stay is required and you can return to your routine activity the next day. Complications are that it may result in injury to the ureter.

In URS, PCNL and RIRS, the urologist may place a tube inside your ureter called a ureteric stent. This is to allow the normal urine flow from the kidney to the urinary bladder and also to allow some tiny stone fragments to pass out. The stent usually remains in place for up to 3 weeks after which it can be removed as a day care procedure under local anaesthesia. With the stent inside your body, you can carry on your regular activities and return to work but do make sure that you get it removed on the date stipulated by your urologist.The stent can cause minor problems to you like burning sensation while passing urine or a pain in the side of the loin where it has been inserted. This pain is usually due to the reverse passage of urine from the urinary bladder to the kidney and will gradually subside with time as the stent and ureter adapt themselves. In case these symptoms persist, you must seek medical care. If the stents are not removed for long time, it will be crystalized slowly and transformed into stones which can permanently damage your kidney. Hence removal of DJ Stent is must.

CYSTOLITHOTRIPSY:

Stones within the urinary bladder that are larger than 10mm are removed by this method. Here a straight tube is inserted into your urinary bladder via the natural urinary passage and the stone is broken and removed. This method is also used for stones within the urethra. Only a single day’s hospital stay is required

OPEN CYSTOLITHOTOMY:

Stones within the urinary bladder that cannot be removed by cystolithotripsy are removed by this method.
Here an open surgery is required and you will need 4 to 5 days of hospitalization.