The treatment of stones depends on location of stone, size of stone and presence or absence of any obstruction. The common modalities are
Medical Expulsion Therapy:
The use of alpha blocker medicines is known as Medical Expulsion Therapy. Alpha-blockers are known to help the smooth passage of kidney stones, also known to decrease the time of the passage, and reduce the need for analgesia during the passage. Also used after shock wave lithotripsy. Moreover, medical expulsion therapy reduces the need for surgical intervention an d hospitalization.
α-blockers are often used in the management of distal ureteral stones.
ESWL- Extra Corporeal Shockwave Lithotripsy:
Extracorporeal Shockwave Lithotripsy is chosen as a treatment in case of small kidneystones ire less than 2cms (an inch) in size. This is the procedure done on an outpatient basis and is the least invasive. The stone is identified using ultrasound/ X-ray and the stone is broken into fragments of a smaller size, by passing shock waves form the outside. shock waves are applied from outside the body to break the stone into smaller fragments which are then passed in the urine.
Rigid or Flexible Uretero-renoscopy/ Intra-corporeal Lithotripsy:
This is used to treat any type of urinary stone, recurrent stones, or stones resistant to the above ESWL treatment. Uretery stones / stones in the lower portion of the kidney are treated using ureteroscopy. This is the procedure done on an outpatient basis and is the least invasive. To enable the urologic surgeon to observe the stone, a fiberoptic ureteroscope of small diameter, is placed into the ureter, through the bladder. The stones are then broken into smaller fragments by the help of surgical instruments. They can then use surgical instruments to remove the stone, or a laser to break it into smaller pieces that can be passed in the urine.
The surgical procedure of the kidney using a fiberoptic endoscope the viewing tool is called Retrograde intrarenal surgery (RIRS). It is performed only by RIRS special experienced
endourologist and is a better,quicker and speedy recovery option over surgery. This endoscope is placed retrograde to intrarenal ie in the bladder thorugh the urethra and in the kidney through the ureter. The scope facilitates the urologist to observe the stones and evaporate using an laser probe/ manipulate and remove by forceps/ crush by an ultrasound probe, etc.
A transurethral cystolitholaplaxy is commonly used for children, and for adults with bladder stones. In case of very large bladder stones, a percutaneous suprapubic cystolitholapaxy is recommended.
A micro telescope ie a cytoscope, is inserted the surgeon into the bladder trough the urethra. After observing the stones, the surgeon grabs the stones using the cytoscope’s forceps or an ultrasound or lasers and tries to break them into smaller fragments so that they can be easily flushed out of the bladder.
Time of the procedure: 30 – 60 minutes.
Anasthetia: General or Epidural.
The Percutaneous Suprapubic Cystolitholapaxy includes an abdomen incision with a small microscopic device, to robserve and emove the stones.
This is the treatment for very large, high in complexity kidney stones in one kidney. It requires an overnight stay and thus an inpatient procedure. It is a very safe and effective treatment capable of clearing all the large stones in one go and complex stones in a repeat procedure.. A highly expert urologist, assisted by the interventional radiologist, make a small incision to connect a channel directly to the kidney’s drainage system. With help of specialized instruments, the stones are shattered and evacuated out of the kidney through the channel.
Laparoscopic Surgery: (Keyhole Surgery)
In case when kidney/ ureter stones are non responsive to other treatments like
PCNL surgery./ endoscopy / ESWL or in patients under the anti-coagulation (blood thinning agents) therapy. It may include a combination of pyeloplasty with laparoscopic pyelolithotomy (kidney stones) / laparoscopic ureterolithotomy (ureter stones. Usually, four small incisions (5mm – 10mm) are made on the abdomen to expose and remove the stones. Post- surgery, an internal stent (fine plastic tube) is then usually placed inside the urinary tract to be removed after 1-2 weeks.
Time of the procedure: 2- 3 days.
All above, treatments are finalized taking into consideration the overall health, severity, age and other ailments of the patient.