Non- Surgical Treatment of Kidney Stones



How to Get Rid of a Kidney Stone: Letting Them Pass and Other Treatment Options

Sometimes Surgery Is the Best Option to Get Rid of a Kidney Stone

Most urologists recommend that stones come out surgically within six weeks (if they don’t pass on their own) because of the risk of the ureter becoming blocked, explains Clayman. This can cause pain, problems with urination, changes in the amount of urine made, and blood in the urine. (

If left untreated, a stone that is blocking the flow of urine can lead to complications, such as permanent kidney damage, recurrent urinary tract infections (UTI), and bleeding, says Dr. Marchalik.

Notably, patients who have a UTI at the same time as a kidney stone can develop sepsis, a life-threatening condition. (If this happens, doctors usually place a tube in the ureter or kidney to drain infected urine,Seth K. Bechis, MD, a urologist at UC San Diego Health in California. In addition, antibiotics are given to treat the infection.

Fortunately, a range of minimally invasive treatments for removing or breaking up kidney stones are available to help prevent such complications from arising.

Shock Wave Lithotripsy

The least invasive outpatient procedure for treating kidney stones is shock wave lithotripsy, saysS. Adam Ramin, MD, urologic surgeon and medical director of Urology Cancer Specialists in Los Angeles.

For this procedure, a doctor uses a machine that generates a targeted high-energy shock wave to the kidney stone under imaging guidance. No incisions are required. “We aim to hit the stone several times,” saysendourology and minimally invasive surgery fellow at The Ohio State University Wexner Medical Center in Columbus. Patients are given general anesthesia, andthe procedure takes about two hours. Urologists target the stone so that it breaks into smaller pieces that patients can then pass on their own — “hopefully without too much discomfort,” adds Dr. Sourial.

Shock wave lithotripsy is often used for smaller stones that are sitting up high in the kidney, so that once they're fragmented, they are likely to pass. Doctors may recommend this procedure when the stone size is less than 2 centimeters (cm) in diameter. (

Patients may have some blood in their urine for a few days after the procedure, but usually can return to work or their usual routine the following day, notes Sourial.

While shockwave lithotripsy is the least invasive of the procedures available for breaking up kidney stones, it’s not always effective. “Sometimes these fragments either just stay in the kidney or are too large to pass through the ureter and out of the body,” says Dr. Ramin.

Ureteroscopy

Another minimally invasive outpatient procedure is ureteroscopy, in which urologists place a small, lighted tubecalled a ureteroscopewith a camera at its tip into the urethra, the passageway that carries urine from the bladder to the outside of the body. They then pass the scope into the bladder, then further up into the ureter, says Ramin. Next, they pass a small laser device through the scope to break down the stone. This laser can pulverize stones of 1 to 1.5 cm into sand-like particles, he says. No incisions are required, and patients receive general anesthesia.

Sometimes, doctors use a basket passed through the scope to remove fragments, says Sourial. The may also place a stent, or a rubber tube, in the ureter that allows particles to pass through the urinary system and out of the body, he says.

Patients who undergo ureteroscopy recover quickly. “They're usually able to get back to work the next day,” says Sourial.But they may have some blood in the urine for a few days after the procedure, he adds.

Those who have a stent visit their doctor about a week after the procedure to have it removed, says Sourial. Doctors use a ureteroscope to do this in the office while the patient is awake. A topical numbing jelly relieves discomfort and the removal takes just a few seconds, Sourial says.

Percutaneous Nephrolithotomy and Nephrolithotripsy

For stones larger than 2 cm, doctors may recommend percutaneous nephrolithotomy or nephrolithotripsy (PCNL). Both of these procedures require urologists to make a small incision in the back to create a pathway to the kidney, through which they insert a nephroscope, a tube with a camera on the tip, and surgical tools. (9)

If doctors use these tools to remove the kidney stone, the procedure is called a nephrostolithotomy. If they use these tools to break up the stone first, the procedure is called a nephrolithotripsy.

Urologists may use a laser or an ultrasonic device that vibrates at a high frequency to fragment stones, says Sourial. Suction on these devices allows doctors to remove pieces of stone. Doctors may also insert a stent in the ureter to help with swelling and so that patients can urinate.

nephrostolithotomy or nephrolithotripsypatients stay in the hospital overnight.
“Typically, we'll recommend people avoid physical exertion for about 10 days to two weeks, so the urinary tract heals,” Sourial says. People can return to work, but may want to perform lighter tasks. A trip to the doctor’s office is required to remove the stent, which is done using a ureteroscope while the patient is awake, Sourial says.

Robotic Assisted Laparoscopic Nephrolithotomy

A robotic assisted laparoscopic nephrolithotomy can be another option for patients with a large stone, says Ramin. For this procedure, surgeons make small incisions in the abdomen through which they insert a laparoscope, a lighted tube with a camera at its tip, and tiny surgical tools to access and open up the kidneys to retrieve the stone. These surgical tools are controlled by the surgeon using a computer console in the operating room.

Ramin recommends robotic laparoscopic nephrolithotomy over open nephrolithotomy, an operation that requires a larger incision in the side of the body. The tiny incisions used with robotic surgeryhelp patients heal quicker and experience less bleeding than with an open procedure, he explains. In addition, with robotic surgery, patients can generally can go home after one or two days in the hospital and go back to work within a week.






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Date: 08.12.2018, 03:11 / Views: 91541