Treatment of Urinary Stones

1.CONSERVATIVE MANAGEMENT

It is usually the treatment of choice for small stones in the kidney and ureter. Most of such stones pass spontaneously in the urine without any need for intervention. The probability of a stone passing down spontaneously will depend upon the size of a stone, it’s location, shape etc. Such patients can be treated with anti-biotics and analgesics to feel symptomatically better. Oral dissolution agents can also be given for a considerable length of time. The patient is generally instructed to maintain a high fluid intake ranging from 2 to 3.5 litres/day.

If a patient has severe abdominal painassociated with vomiting and fever, then admission is usually required and intra-venous fluids may have to be given. If this does not help, then the stone may have to be removed by endoscopy.

Some cases where the stone causes severe obstruction and infection then a procedure called DJ stenting has to be done to releive obstruction. DJ stenting is the process of inserting a synthetic tube between the kidney and the ureter. If this does not help a tube has to be passed directly into the kidney to drain the infected urine.

2.EXTRA CORPOREAL SHOCK WAVE LITHOTRIPSY

Extracorporeal Shock Wave Lithotripsy –Advanced technique in stone removal

Extracorporeal shock wave lithotripsy is recognized world –wide as the most effective mode of treatment for kidney and ureteric stones.It is a highly scientific technique employing focused shock waves for breaking urinary stones into fine particles.This technique was introduced in 1980 by a German company. Ever since the introduction,of this technique,it has been successfully used by Doctors in USA,Europe and other areas of the world ,for the treatment of urinary stones.

It is a non – operative technique with no necessity for anaesthesia and involves minimal pain.Unlike the earlier open operation treatment, ESWL does not involve any cutting of tissues and no scars are left after the procedure.

The ESWL procedure usually lasts for about 40 minutes.But depending on the size and number of stones,more than one session may be required for proper breaking of the stones.

Patients may be required to remain in the hospital for a day for observation.After the procedure the patient is adviced to drink plenty of fluids.This helps in the passage of stone fragments in the urine.In some cases, certain other procedures may have to be adopted to facilitate full removal of the stone fragments.

3.URETEROSCOPIC STONE REMOVAL

It is ideally suited for stones in the lower portion of the ureter. It involves the passage of an instrument namely ureteroscope through your urinary passage. The instrument is as thick as a pen and is about 40 cm long. You may have to be admitted in the hospital for a few days (2-3 days) for this procedure and it has to be done under anaesthesia.

A variety of other instruments can be passed in through the scope which can be used to break the stones and remove them. Very rarely it may so happen that the stone cannot be removed by this method in which case open surgery may be needed.

4.PERCUTANEOUS NEPHROLITHOTRIPSY

This procedure is ideally suited for very large calculi within the kidney and the upper ureter. In this procedure, a puncture is directly made on to the kidney, the stone is seen with a telescope, broken into fragments and the fragments removed.

In some cases, it may not be possible to remove the entire stone. So a combination of other procedures like ESWL has to be done to ensure that the stone is completely removed.

5. OPEN SURGERY

With the advent of new technologies to treat stone disease, the need for open surgery has been drastically reduced. But in some cases it might be required. The type of open surgery will depend upon the site and size of the stone within the urinary tract.