Kidney stone treatment part 2

 Laser treatment for kidney stone

   Laser lithotripsy isan advace treatment can be performed under general anesthesia, This procedure can be used to remove or break up (fragment) stones located in the ureter or kidney. A special telescopic instrument ccalled, flexible ureteroscope is inserted through the urethra and passed through the bladder and up the ureter to the stone. The light energy of the laser is transported through a light guide to the stone. The important factor is fiber is very thin it can bend with the flexible ureteroscope to reach any location of the kidney .
Stone fragmentation occurs when pulses of intense laser light are applied. The fragments are then passed by the patient or removed with a basket.

Advantages of Laser Kidney Stone Treatment

 

•  We dont need open surgery
• We can identify stones any location in ureter or kidney with 99% success rate.
• We can treat stones up to 3 cm.
• One day of hospital stay only.
• We can back to normal duties with in 4 days.
• Best option in bleeding diathesis.
• Best option for hard stones.
• Best option for stones in very dependent lower calyx.
• Best option for post PCNL residual stones.
• Best treatment for Pilots with multiple small kidney stones.
• Best treatment for Pregnant women, morbid obesity,

Keyhole surgery

Keyhole Surgery (PCNL) is a well-established procedure by which stones in the kidney or the upper ureter are removed by making a small incision in the flank. Generally, an incision, that is 1 cm or less than 1 cm, is made in the flank. A guide wire is passed through this incision into the kidney. Keyhole Surgery is performed under fluoroscopy or x-ray control.

Method :

A passage is then created around this guide wire by dilatation. Through this passage, a nephroscope is passed into the kidney to visualise the stone and remove it. Larger stones can be fragmented by different methods and removed. Stones are therefore cleared easily. Once the procedure is complete, a tube is left through this tract as drainage for one or two days.

Advantage & Other notes:

The main advantage of this method is need not open surgery, only a 1 cm incision is made in the flank. The stones can be visualised directly and removed. Unlike ESWL or ureteroscopy, the stones are removed in the same sitting and the kidney is cleared of calculi. The stay in the hospital is only for 3-4 day

This surgery would be recommended as a treatment of choice, if the patient has kidney stones larger than 2 cm

This procedure is commonly performed under general anaesthesia, and therefore you also need to be admitted to the hospital for this procedure.

The success rate of clearance of stones with this procedure ranges between 90 to 95%. This actually depends upon the size, number and location of these stones. Sometimes, complete clearance may require a second procedure after a few days.

For the post-operative course, the patient will generally need to stay in the hospital for 2 to 3 days after the procedure. Patient examine the studies if any stone is prsent in the kiney.

Rare complications include persistent uncontrolled bleeding due to arteriovenous malformations or pseudo-aneurysms (0.4%), which would need secondary procedures. When a supracostal puncture (above the 12th rib) is made, complications would then include pneumothorax (commonly called collapsed lung caused due to the accumulation of air or gas in the space surrounding the lungs) or fluid accumulation in the thorax. Again, the incidence of these is only 0-4%.

Most patients return to average activity levels within a week or so. A return to vigorous activity should probably take place after 4 weeks.

Link here for Kidney stone part 1