Treatment for Kidney Stones in Lucknow, Uttar Pradesh

How are kidney stones diagnosed?

Most of the urinary stones are formed in kidney and may either remain inside the kidney or travel through ureter, tube connecting kidney to bladder.  Kidney stones are visible on ultrasonography and often on x-ray. Many times stones are silent and are picked-up on ultrasound or x-ray done during general health check-up or for any other condition. Some tiny stones pass out of body unnoticed. Commonly, one complains of pain in flank often severe compelling to visit hospital emergency. At other times, one may see blood in urine or have burning sensation while passing urine. Sometimes, one may have fever which is indicative of infection. Occasionally, the only symptom is prolonged loss of appetite and nausea which may indicate deterioration of kidney function. Ultrasound and x-ray provide valuable information of size and location of kidney stones. Blood and urine tests help detect abnormalities that might promote stone formation.

Sometimes, information on ultrasound and X-ray is not sufficient. Doctor may decide to scan the urinary system using advanced tests, such as computed tomography (CT scan) or intravenous urography (IVU). Results of all these tests help plan appropriate treatment.

What are the treatment options for kidney stones?

Stone disease is a recurrent problem; in other words these tend to form again even after successful removal. Therefore, dietary changes, and sometimes, medical treatment are required to prevent recurrence.

Conservative measures include –

Hydration – drinking plenty of liquids not only helps small stones to flush out, but also prevents recurrence.

Medication – your doctor may prescribe medication depending on the situation. For example, for a painful stone stuck in ureter, the doctor will prescribe medication to control pain and to facilitate flushing out of the stone (same medications are prescribed for men with prostate problems). In other instances, you may need antibiotic in case there is infection or occasionally medication to dissolve specific type of stone (e.g. uric acid). Patients who are forming stones very frequently are often prescribed specific preventive medication.

Diet – your doctor will advise some long-term changes in your diet which would help decrease recurrence. For example, you will be advised to curb salt and sugar in your diet and to take adequate amount of milk products with food. Some specific changes may be advised depending on the type of stone.

When is surgery needed to remove kidney stone?

Very small stones in the kidney (generally speaking less than 5mm) which do not cause any pain or infection may be left alone for observation. However, most of the other stones would commonly need to be removed. Some such circumstances are as under –

  • Bigger stone in the kidney even if it is not causing pain or infection
  • Stone stuck in ureter for long time causing severe symptoms; nevertheless, many such smaller stones may be successfully expelled with medication and hydration. Your doctor will decide the length for which wait and watch may be followed
  • Any stone causing infection or constant bleeding
  • Stone causing blockage in flow of urine from kidney causing back pressure changes which can potentially damage the kidney function
  • Stones getting bigger on follow-up scan

Up until late 1970’s open surgery was predominant mode of surgical treatment requiring big incision and prolonged recovery ranging 4-6 weeks. Over last several decades technology has greatly advanced and such surgeries are rarely, if ever, required. Most small stones can be managed with no-incision minimally invasive procedures as a daycare. Even large stones can be tackled with key-hole surgeries, whether through hole in kidney or by laparoscopy.

What are different surgical treatments for kidney stones?

1. Extracorporeal shock-wave lithotripsy (ESWL)

This is one of the commonly performed procedures for small stones in kidney or ureter. It is done under sedation and most of the time you will be discharged on the same day. It does not require any instrumentation or cut on the body. Shock-waves are produced outside the body using electromagnetic waves in highly specialized equipment. These are targeted on the stone using X-ray or ultrasound guidance and travel through the skin and tissues and hit the stone. The stone is broken into small fragments which then pass-out through urine over a period of time.

2. ureterorenoscopy (URS)

This is the most commonly performed endoscopic procedure for urinary stones. It is done under full anesthesia, nevertheless most of the time you will be discharged on the same day. It is an endoscopic procedure not requiring any cut on the body. this involves a fine caliber instrument is passed through natural urine passage upto the stone, the stone is broken into small pieces using laser, ultrasonic or ballistic energy source and the resulting fragments may be either removed using specialized baskets or be left to pass out later. Quite often a small tube (called a stent) is placed along the ureter for few days to help flow of urine from kidney. The stent must be removed by a small endoscopic procedure once its work is done (mostly in 10-21 days).

Most ureteric stone can be managed with this technique. Most small to moderate size kidney stones (typically smaller than 2.5cm, or even larger if soft in nature) may also be tackled with this technique; however, it requires more advanced and delicate instrument called flexible ureterorenoscope (either fibre-optic or digital) and a laser energy to pulverize the stone.

3. Percutaneous neohrostolithotomy (PCNL)

This is a major surgery done through small cut (most often one, sometimes more) on the back in kidney region. A passage (tunnel) is created from skin into the kidney under ultrasound / x-ray guidance, stone is located through specialized instrument called nephroscope, broken into small fragments using ultrasonic, ballistic or laser probe and fragments removed at the same time.

After this operation, the patient usually has to remain in hospital for few days (most commonly 2-3 days). Often the doctor will keep a tube (nephrostomy) coming out from kidney for drainage which will be removed before discharge. Sometimes, an internal stent (similar to ureterorenoscopy) is also kept inside for unobstructed urine passage into bladder.

This is the procedure of choice for very large stones in the kidney or those which are not amenable to ESWL or URS due to location.

4. Laparoscopic pyelolithotomy –

This is a major surgery, a type of key-hole surgery done through 3-5 small cuts on the side or front of your tummy. This is performed in rare circumstances when PCNL is deemed inappropriate particularly in case of persistent infection, or when stone is placed just outside the kidney and hole in the kidney can be avoided.  

5. Laparoscopic ureterolithotomy –

This is a major surgery, a type of key-hole surgery done through 3-4 small cuts on the side or front of your tummy. This is performed when URS is deemed inappropriate particularly in case of persistent infection or very large stone.