Kidney Stone
Our team at the NKPC kidney clinic, is highly experienced in the management of renal stone disease and we have treated more than 5000 cases of stone disease.
Our team of uro-surgeons
Dr Avishek Mukherjee MS (AIIMS), MCH URO (PGI Chandigarh)
Dr Moloy kr Bera MS MCH
Dr Sandip Pramanik MS MCh
Dr Anurag Chaterjee MS MCH
Medical Management
WHY DO KIDNEY STONES OCCUR?
Kidney stone formation is a rather common ailment caused by imbalance between the amount of calcium and oxalate excreted in the urine versus the amount of citric acid, which prevents stone formation. People who are genetically more predisposed to stone formation have this imbalance and therefore they should take measures to reduce the chance of stone formation.
WHAT IS THE USUAL PRESENTATION OF KIDNEY STONES?
Kidney stones usually present with pain. The pain of stone disease is generally located on the side towards the flank region of the patient. This pain usually migrates as the stone passes downwards towards the bladder. The pain is usually very severe and colicky in nature. Some patient however may have silent stones with no manifestation of the disease.
HOW ARE KIDNEY STONES DIAGNOSED?
Kidney stones are usually first detected by routine Ultrasonography or USG of the kidneys, but for final planning of the management of these stones a CT scan is a must.
Normal we advise for a NCCT KUB, which means a painless no injection, CT scan to assess the stone size, number and location. Also the kidneys can be seen very clearly and therefore the status of the kidney function can also be assessed.
If the kidney function appears compromised then a surgeon may ask for a contrast CT Scan of the kidney.
Nowadays we perform this test with the advanced low radiation system of Somatom – Go now at the NKPC kidney clinic. This allow accurate diagnosis and at the same time the radiation risk to the patient is very very low.
Surgical Management
Kidney stone
Which stones need surgery?
Stones which are symptomatic, causing pain or infection, need intervention. Stones which are smaller than 5 mm are generally not operated.
How are the stone removed?
Open stone surgery is rarely needed nowadays. Most stones, if not all are, cleared completely by endoscopic stone surgery. This means surgery via PCNL or RIRS.
What is PCNL?
Per-cutaneous nephro-lithotomy
PCNL surgery is a microsurgery where in, a very small incision, generally smaller than 1cm is placed in the back of the patient. This incision is so small that no stitch needs to be applied. Through this opening, using a nephro-scope, the uro-surgeon can gain excellent visualization of the kidney and through this complete clearance of the kidney stone is achieved.
This is the gold standard for all kidney stones, and provides excellent clearance of all renal stones. Generally the patient has excellent post operative recovery, with minimal pain.
What is RIRS?
Retrograde intra-renal surgery
This procedure means removal of the kidney stone by using a flexible uretero-renoscope. This is a very fine and flexible telescope, which is introduced via the natural passage of urine. Therefore no incision is needed for this procedure. Via this telescope the uro-surgeon is able to enter and inspect from within all the chambers within the kidney and then remove the stones as they are found. Once the stone is brought down from the kidney to the upper ureter, it is then vaporized using a powerful holmium laser beam.
This procedure benefits the patient since it avoids any incision while clearing the stone completely.
WHAT IS THE USUAL PRESENTATION OF KIDNEY STONES?
Kidney stones usually present with pain. The pain of stone disease is generally located on the side towards the flank region of the patient. This pain usually migrates as the stone passes downwards towards the bladder. The pain is usually very severe and colicky in nature. Some patient however may have silent stones with no manifestation of the disease.
HOW ARE KIDNEY STONES DIAGNOSED?
Routine evaluation by ultrasonography and plain X-ray KUB are generally sufficient to diagnose stone disease. However to assess the status of the renal function the urosurgeon generally advises IVP intravenous pyelography, to plan the treatment of the patient. In case of radio luscent stones a CT scan study may also be recommended.