Dr. Suresh Prasad Aggrawal, M.S., D.N.B.(Urology). Consultant Urologist, Andrologist & Kidney Transplant Surgeon, Patel Hospital Jalandhar
Treatment of kidney stone disease is dependent on factors such as size, the hardness of stone and the site of the stone. These parameters are determined on the CT scan.
ESWL– Extracorporeal Shock Wave lithotripsy— Kidney stone of size up to 1.5 cm and are not hard can be broken with the procedure called external shock wave lithotripsy which is scarless day care procedure done under local anesthesia. However, it requires multiple sessions and may not give the complete clearance of the Kidney stone.
PCNL – Per (through) Cutaneous (skin) Nephro (kidney) Lithotomy (stone breakage) is the procedure generally used for large Kidney stones of size more than 2-3 cm. In this procedure, the hole is made into the lower back of the patient and tunnel created until the level of the kidney after giving complete general anesthesia. An endoscope is passed through this tunnel and Kidney stones are then broken with either laser or machine called lithotripter. These small holes usually vary between sizes 8-10 mm and heal itself without any suture. A patient may need multiple holes and tracts as per the number and location of the stone within the kidney this procedure usually provide complete clearance if a Kidney stone burden is not large.
RIRS -Retrograde (through natural urine orifice) Intrarenal Surgery (kidney stone removal) is done for stones of size 2 cm though it can be used for kidney stones of large size also. In this procedure which is scarless and done under general anesthesia the flexible endoscope is passed through the natural urine orifice and Kidney stones are made into small powder with the laser. This powder then keeps on passing while the patient urinates in initial few days after surgery a stent is usually kept in the operated kidney which if placed needs removal usually after 4-6 weeks. Large Kidney stones (2 cm or more) may also be treated with this technique but may need more than one session as this procedure takes time. This Procedure is truly scarless, with minimal risk of bleeding and pain-free and daycare procedure.