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Kidney Stone Surgery

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Kidney Stones: Causes and Symptoms
A kidney stone is a solid mass of crystals that can develop in the kidneys, ureters, bladder, or urethra.Oxalate, uric acid, sodium, potassium, calcium, sodium, and phosphate are some of the compounds found in urine. The particles may clump and crystallize if the concentrations of these particles are too high or if the pH of the urine becomes excessively acidic or basic.If the issue is not resolved, the crystals will progressively develop over a few weeks, months, or even years, eventually becoming a discernible stone.Kidney stones form inside the body but are extremely painful to get out of.It’s possible for a kidney stone to go unnoticed until it starts to move.

Courtesy: Brojen Barman

The walls of the urinary tract are scratched by the sharp edges of a stone as it passes through the kidney and into the ureter.Blood may spill into the urine as a result of scratches. Nausea, vomiting, and a burning sensation when peeing are a few of its side effects.
If the stone gets big enough to actually block the flow of urine, it can create an infection, or backflow, and damage the kidneys themselves.However, the majority of kidney stones don’t get this bad or even need invasive treatment.Typically, masses with a diameter of less than 5 mm will leave the body on its own. A doctor will often simply recommend drinking large amounts of water to help speed the process along and maybe taking some painkillers.

Extracorporeal Shock Wave Lithotripsy (ESWL)
One method is to use sound waves to crush stones that are up to 10 mm in size.Extracorporeal shock wave lithotripsy (ESWL) uses high-intensity pulses of focused ultrasonic surgery aimed directly at the stone. The pulses create vibrations inside the stone itself, and small bubbles jostle it. The stone is broken into smaller bits by the combined effects of these forces, making it easier for them to exit the body.

Courtesy: Mount Sinai

But zapping a stone with sound doesn’t work as well if it is simply too big. So sometimes, more invasive treatments are necessary. This is where the surgical procedure of ureteroscopy comes into play to address the problem of kidney stones.

Courtesy: Medanta

Ureteroscopy is typically performed with the patient under general anesthesia, a small, rigid tube called a “stent” is passed through the urethra into the bladder and from there up into the ureter and into the kidney. A contrast study may be performed to assess the anatomy of the renal collecting system to perform stone removal. A rigid or flexible ureteroscope is inserted via the urethra into the bladder, depending on where the stone is located.The surgeon looks carefully for stones, tumours, or other problems. Both ureteral openings are inspected. A guide wire is inserted into the ureter through the cystoscope before performing a ureteroscopy. The wire in the ureter directs a ureteroscope to the stone.
Once the stone has been discovered, it can either be removed immediately using a stone basket or it can first be broken up into smaller pieces using a laser. It would then be grasped and slowly extracted. The collection system is examined to make sure no residual stones were missed after the stone extraction. To guarantee that swelling does not obstruct urine outflow, the surgeon may insert a stent into the ureter at the end of the treatment. The bladder can be drained using a catheter, a tube that is inserted through the urethra and into the bladder. This catheter remains in place with the help of an inflated balloon. Immediately following the procedure, the catheter and stent are removed.

Courtesy: North Shore

Besides ureteroscopy, PCNL (percutaneous nephrolithotomy) is another similar surgery that takes out large kidney stones from the kidney directly. The kidney stone is located and removed by the doctor using a nephroscope, a narrow viewing instrument. Through a small incision made in your back, the doctor puts the instrument directly into your kidney. The doctor might also employ a laser to cut larger kidney stones into more manageable bits. The doctor uses anesthesia to conduct PCNL in a hospital. After the procedure, you might need to stay in the hospital for a few days.Studies have shown that this process is safe and successful despite being more invasive than other stone removal methods. It also has a higher level of patient satisfaction.

The outlook for kidney stones is quite optimistic, notwithstanding the possibility of recurrence (the stones returning). Numerous kidney stones dissolve on their own over time without requiring medical attention. Larger kidney stone removal with medication and surgery is typically quite successful and requires little recuperation time.You might experience kidney stones more than once in your lifetime. If you keep developing kidney stones, your doctor might work together with you to figure out the cause. You might have to alter your diet after the cause is identified in order to avoid getting stones again.A person’s best line of defence against the creation of stones is to reduce risk. Knowing the specific ingredients that made up a kidney stone that was passed or removed can also help in implementing focused prophylactic measures to ensure that future forms have little likelihood of forming.

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