Surgery is the last option when all other treatment options fail to provide relief from kidney stones. This article provides information regarding the same.
Kidney stones are formed when the concentration of substances in the urine such as calcium, oxalate, and phosphorus becomes high. They vary in size and are classified into four major types such as calcium stones, uric acid stones, struvite stones, and cystine stones. The calcium stone is the most common type of kidney stone found in people. A small stone may pass out through the urine with mild or no pain, whereas a large stone may block the urine flow causing severe pain. Sometimes bleeding may also occur if the stone is large.
Causes
Following are some of the causes that may form stones in the kidney:
- Hypercalciuria
- Hyperparathyroidism
- Cystinuria
- Hyperoxaluria
- Hyperuricosuria
- Gout
- Family history
- Cystic-kidney disorders
- Obesity
- Inadequate consumption of fluids
Treatment
The treatment usually depends on three main factors:
- Size of the stone
- Composition of the stone
- Whether the stone is causing pain or blocking the urinary tract
Though the small stones pass out of the urine, the patient may be administered oral medications to relieve the pain. Along with medications, the patient may be asked to drink plenty of fluids. If the patient is unable to intake fluids or is dehydrated due to vomiting, then intravenous medication may be administered.
The first line of treatment always consists of a conservative approach, wherein there are attempts made to get rid of the stone without the need for surgical intervention. However, in cases where the stone is either too large, or in cases where the person is feeling acute pain, then surgical intervention is preferred as a treatment option. Following are various surgeries for treating kidney stones:
Ureteroscopy
This simple surgery involves fragmenting or breaking up the stone into small pieces. This procedure is preferred if the stone has passed from the kidney into the ureter. A ureteroscope (a long, tubelike device with an eyepiece) is passed through the urethra while the patient is under general anesthesia. Once the stone is located, it is either removed by being scooped out with the help of a small basket or pouch attached at the end of it, or it is broken into small pieces with a laser. Once the stone is fragmented into small pieces, the patient is asked to drink adequate amount of water so as to pass the stone naturally. The patient can go home on the same day.
Lithotripsy
Lithotripsy is the surgery of choice in cases where the stone may be present in the kidney or in the upper ureter. This procedure uses a probe or a machine called lithotripter to break the kidney stone into smaller fragments. Although this surgery is the most effective of all, it is not suitable for patients with certain other disorders. Following are the types of lithotripsy, which are performed under general or local anesthesia:
Ultrasonic lithotripsy: In this procedure, an electronic probe inserted into the ureter. High frequency sound waves are passed through the probe that break the kidney stone into pieces. These smaller stones are either removed surgically or passed out in the urine.
Electrohydraulic lithotripsy (EHL): In this procedue, under the guidance of a ureteroscope, a flexible probe is positioned close to the stone, which is broken into smaller stones with the help of electrical shock waves. These stone fragments are either removed by the surgeon or passed out in the urine by the patient.
Extracorporeal shock wave lithotripsy (ESWL): In this procedure, the patient lies on a table or in a tub of water above the lithotripter (a machine used to crush the kidney stone). The shock waves generated by the lithotripter pass through the patient’s body and break the kidney stone into smaller pieces. These stones can now be readily passed through the urine. However, this procedure should not be performed in pregnant women, or in cases where the stone is very large, or in patients with struvite stones.
Percutaneous Nephrolithotomy (PCNL)
This procedure, which is performed under general anesthesia, may be used for treating larger stones. It may also be performed in patients for whom ESWL is not a suitable option. In this procedure, an incision is made in the back of the patient. A nephroscope (a thin telescopic instrument) is inserted into the kidney through the incision. The stone is either extracted or broken into pieces using shock waves. After the surgery, the patient needs to stay in the hospital for several days, and a nephrostomy tube is inserted through the skin into the kidney which drains out the urine and any remaining pieces of stone.
Open Surgery
This is the last option that is considered while dealing with a kidney stone and is rarely used nowadays. This is performed only when the stone is very large in size or very solid due to which it does not break into fragments easily. Using general anesthesia, the surgeon makes an incision in the patient’s back, after which the stone is extracted through an incision in the ureter or the kidney. This procedure requires prolonged hospitalization and the patient takes substantial amount time to recover.
The surgery cost depends on many factors like the type of surgery performed, the size of the stone, risks and complications encountered, etc. After the surgery, one must drink plenty of water, take proper medications and ample amount of rest, and follow the instructions provided by the physician.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a replacement for expert medical advice.
