DR. MAYANK MOHAN AGARWAL
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Treatment for Kidney Stones in Lucknow, Uttar Pradesh

Urinary stone disease (urolithiasis) is a ubiquitous problem; no place or person of any age is exempt from it. Most stones form within the kidney; only a few would form primarily in bladder. The problem is ever increasing over last few decades, largely due to changes in our diet and life-style. Kidney stone disease not only poses a threat to functioning of the body by causing pain, urinary infection (which may be life threatening), loss of kidney function and kidney failure (with need of dialysis / transplantation), their treatment causes humongous economic burden to the self as well as health system of respective country. For example, a data from USA revealed annual expenditure of $2.1b in 2000 which increased to 4.5b in 2012, and it is ever increasing.

Management of stones involves not only retrieving the existing stones but also to take measures to prevent recurrence; upto 50% of stone formers have at least one recurrence in their lifetime. Kidney stones form when urine becomes concentrated with stone-forming elements or there is deficiency of stone-preventing elements. Habits like drinking less amount of water / liquids, avoiding milk products (e.g. milk, paneer, curd, butter milk, etc.), taking too much salt, animal proteins (meats), refined sugar, high-oxalate foods (e.g. spinach, dark chocolate, nuts, potato, yam, etc.), fast food and avoiding citrus fruits contribute to stone formation. In addition, stone disease is associated with metabolic syndrome (i.e. diabetes mellitus, hypertension, coronary artery disease, obesity, high uric acids in blood), certain hereditary diseases, hormone disturbances and urinary tract infections, etc. Therefore, evaluation is kidney stones is not restricted to imaging (x-ray, ultrasound, CT); a detailed assessment for dietary habits and specialized blood / urine tests is mandatory. All stone-patients should habituate themselves to certain dietary and lifestyle modifications to prevent recurrence; taking enough liquids (for producing ~2.5L urine everyday), avoid excessive salt, meat, sugar and fast-food intake, taking enough milk products with food, taking citrus fruits, regular exercise to avoid obesity are simple measures for keeping stone recurrence at bay.

In the pre-endoscopy era, most stones would require major open surgery to remove stones. However, with continuous advancements taking place in the technology of endoscopy and lasers, now-a-days most stones can be managed by endoscopic methods (eponymed ENDOUROLOGY). For large stones in the kidneys, a passage is created (<1cm size) though the skin directly into kidney and stone is broken down using an endoscope. This procedure is called PCNL. Most stones in the ureter (tube connecting kidney with bladder) can be managed by endoscopic procedure done through natural passage (urethra) called ureteroscopy; no cut is required in this procedure. Stone are broken and fragments are left to pass by themselves. With recent advances even stones in the kidneys can be broken through natural passage using laser and flexible (bendable) instruments (called RIRS, the retrograde intrarenal surgery). With laser, stones can be reduced to tiny particles like dust / sand, thus improving clearance.

Most of the urinary calculi can be managed with endoscopic methods mentioned above. However, there are circumstances where these methods may be inappropriate, for example in presence of structural block in the urinary passage, persistent urinary tract infection, advanced kidney disease. In such situation, laparoscopic (keyhole) surgery can be utilized providing the benefit of conventional open surgery but with minimized morbidity.