Kidney Stones : What are the
Treatment Options?
You may have a few therapy choices if kidney stones, also known as urolithiasis, have been identified in you. These include ureteroscopy, percutaneous nephrolithotripsy (PCNL), extracorporeal shock wave lithotripsy (ESWL), and medicinal therapy.
An overview of the urinary tract’s anatomy
The urinary tract consists of
> Kidneys, two organs that remove excess water and waste from the blood
> Ureters, the two tubes that each kidney uses to send urine to the bladder
> Bladder, the organ that holds pee
> The urethra is a single channel that the body uses to expel urine from the bladder.
The kidney stone assessment
An evaluation that includes imaging is frequently the first step if your symptoms point to kidney stones. An intravenous pyelogram (IVP), a form of abdomen x-ray, was the accepted standard of therapy for a long time. This is no longer used in the majority of hospitals; instead, unenhanced helical CT scanning is used. Renal ultrasound can be used as a substitute in some circumstances, such as when a person has decreased renal function or an allergy to contrast dyes.
Blood tests, such as those for renal function (creatinine, BUN), will also be administered to you. Further blood tests may also be recommended by your physician. If an infection is suspected, a urine culture will be provided along with the results of the urinalysis.
Treatment with Medication for Kidney Stones
According to the majority of data, stones smaller than 10 mm in diameter have a good possibility of naturally exiting the urinary system. You can be recommended to undergo medical expulsive therapy (MET) with an alpha blocker drug such as tamsulosin. It’s critical to recognize that this is an off-label use of the medication. Intraoperative floppy iris syndrome is a rare complication that tamsulosin and can occasionally develop and complicate cataract surgery.
The use of MET is still debatable, and not all specialists agree that it is beneficial. Talk to a urologist or your doctor about your options.
lithotripsy using Extracorporeal Shock Waves
Every shock wave lithotripsy device sends shock waves through the kidney stone’s skin. The stone receives most, but not all, of the energy from the shock wave.
The best indicator of ESWL success is stone size. In general:
> Stones smaller than 10 mm can be successfully treated with ESWL;
> Stones bigger than 20 mm are typically not successfully treated with ESWL.
Because the shards of a lower third kidney stone may not be completely removed from the kidney following fragmentation, these stones can also be harmful. These kidney fragments don’t exit the kidney as quickly as kidney fragments from the middle and upper thirds because of gravity.
The effectiveness of ESWL treatment is also influenced by obesity. The skin-to-stone distance (SSD) will be computed by the urologist to assess the likelihood of treatment success.
Among the potential side effects of ESWL
> Hemostases, or bruises to the kidney tissue, can happen occasionally but normally go away on their own with no further care.
> In the ureter, fragmented stones may build up and become obstructed. This is referred described as a “street of stones,” or steinstrasse. Any issues related to steinstrasse are frequently reduced by a ureteral stent. The procedure takes a few days or weeks to complete.
> Hypertension occurs in a tiny subset of patients receiving ESWL, while the exact mechanism is unknown.
> There have also been reports of an elevated risk of diabetes mellitus after ESWL. Nevertheless, sizable population research conducted at the same institution did not support these findings.
Intraoperative nephrolithotripsy:
During percutaneous nephrolithotripsy, a surgeon makes a tiny incision in the lower back to access kidney stones under the supervision of ultrasound or fluoroscopic imaging. The stones are broken up by a power source, like a laser or ultrasonography, and then the pieces are removed from the kidney using an internal stent or external tube.
Greater kidney stones (2 cm or more), complicated stones, or lower pole renal stones greater than 1 cm are typically candidates for this treatment. Complications could include bleeding, infection, and harm to the organs nearby.
Ureteroscopy:
During a ureteroscopy, a surgeon inserts a tube into the ureter, possibly all the way up into the kidney, via the urethra and bladder. Using semirigid or flexible equipment, ureteroscopy provides the surgeon with a great view of the entire inside of the urethra. The stones are then broken apart under direct observation by the surgeon using a power source that is threaded up through the ureteroscope. The urologist may decide to insert a postoperative stent for a few days.
While they are rare, complications can include sepsis and ureteric damage or constriction.