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.

Ureter Stone treatment

Which ureter stones can be managed by medical intervention?

Those stones which do not cause much pain and the kidney function remains good can be managed by medicines, waiting for the stone removal. However a maximum period of two weeks can be allowed for the stone expulsion. These medicines act on the lower most part of the ureter where the ureter enters the urinary bladder. These medicines like tamsulosin relax the lower ureter muscle sphincter and therefore allow the stone to pass. However if the patient has severe pain or there is imminent kidney damage the patient must be immediately treated by ureteroscopic intervention.

Which stones are removed by laser ureteroscopy?

Those stones which are not suitable for medical management are better removed by endoscopic intervention. These stones are generally badly impacted and cause severe pain and renal impairment.

Medical Management

WHAT IS THE MEDICAL MANAGEMENT OF URETERAL STONE DIESEAS ?

When the stone passes into the lower ureter (the tube which conveys the urine from the kidney to the bladder), the ur-surgeon advises medicines like tamsulosin which assist in dilating the lower part of the ureter, and therefore assist in passage of the stone.

h6 style=”background: #dcdee4; padding: 8px 3px;”>Surgical Management

WHICH STONE OF THE URETER NEED ENDOSURGICAL MANAGEMENT?

However all stones are not medically manageable. Those stone which cause severe intractable pain, or endanger the renal function are better removed by endosurgical stone removal procedure. In these cases the stone is accessed and then removed using a ureteroscope, which allows the surgeon to visualize the ureter via the natural urine passage of the patient without the need to make an incision or puncture of the skin

WHAT IS URETEROSCOPIC STONE REMOVAL?

Ureteroscopy is removal of the stone in the lower ureter using an endoscope which accesses the ureter via the urine passage of the patient. This is an ideal and effective treatment to cure lower ureter stones. Those stones which are larger than 6mm, and are obstructing the kidney, resulting in compromise of the renal function are better removed via this technique. The patient is usually discharged on the same day or after overnight stay and the patient can resume normal work after seven days rest at home. If a stent has been placed then the stent is removed in a day care procedure after the IVP has demonstrated stone free status with good renal function

URINARY Bladder stone

Bladder stones are called primary stones when they are formed within the bladder. This can be caused only when there is stagnation of urine within the bladder.

Why do bladder stones occur?

Stagnation of the urine within the bladder can be caused when there is obstruction to the outlet of urine, for example in male patients, bladder outlet obstruction or prostatic obstruction can cause stagnation of urine within the bladder resulting in urinary stone formation.

What is the usual presentation?

These patient generally present with poor urine flow and frequency of urine, however some patients may also complain of red coloured urine which means blood in the urine.

How are they treated?

This can be managed by endo-surgery wherein the stone is removed by laser inserted through a telescope for complete fragmentation and removal of the stone from the bladder. However the primary bladder neck or prostatic obstruction has to be tackled in the same sitting or else the patient can have recurrent stone formation.

How to prevent the recurrence of bladder stones?

Once the bladder has been freed of the stone and the obstruction caused by the prostate or tight bladder neck has been taken care of the bladder stone prevention then depends on changing the chemical composition of the urine. This is achieved by citric acid replacement via fruits like musambi and oranges these can increase the citric acid content of the urine and therefore prevent calcium crystal accumulation resulting in stone reformation.

Advance Therapy (Laser)

At National Kidney and Prostate clinic we use AURIGA XL Holmium Laser system for endo-vaporization of stones. This prevents stone retro-migration and therefore ensures complete clearance of stones. This procedure is performed under general or regional anesthesia. This procedure requires the patient to stay in the hospital for 1-2 nights.

LASER SURGERY FOR KIDNEY STONE DISEASE

Laser has added additional reach to endoscopic surgery for kidney stone diseases. Laser energy is a focused light energy which is able to vaporize the stone. This treatment allows the urosurgeon to completely clear kidney stones. The surgeon first accesses the stone using a nephroscope or ureteroscope and then the surgeon uses the laser to vaporize the stone.

What is laser ureter stone surgery?

These patients are generally treated under regional anesthesia. Therefore the patient is conscious but feels no pain since the lower portion of the body has been anesthetised. The surgeon introduces a fine rigid telescope which is called a ureteroscope. Via this ureteroscope the surgeon can apply the holmium laser beam to completely vaporize the stone. Generally a temporary stent is placed within the ureter which supports the ureter and allows easy transit for the urine while the ureter recovers over the next two to three weeks from the injury caused by the stone impaction .

Kidney stones are one of the commonest problems affecting humans. Kidney stones are usually formed by deposition of calcium oxalate crystals within the urine. Kidney stones cause obstruction to the flow of urine and as a result can cause damage to the kidneys and infection.

Kidney stone surgery was in the past always by open surgery and therefore was always a major procedure and had significant pain and morbidity. Today kidney stone surgery has been revolutionized with the availability of laser energy. Laser energy is a highly focused light energy which can destroy the stones.

The second invention which has revolutionized kidney stone surgery is the invention of fiberoptic telescopes, which are very fine and flexible. Therefore the surgeon can perform kidney stone surgery, by introducing the telescope via the urinary tract or via a small incision in the back and then can visualize the stone with augmented reality vision.

Today kidney stone surgery is performed with augmented reality vision. This is the third advancement. The kidney stone surgeon uses high-definition camera systems which are medical grade. Then the stones are seen in a magnified vision with augmented clarity. Therefor the vision is superior to what the surgeon can see with the naked eye.

Therefore, kidney stone surgery stands revolutionized today with the advent of these three inventions, laser energy, advanced fiberoptic telescopes, and augmented reality camera systems. Now we can perform kidney stone surgery with minimum blood loss and trauma and the patient can recover and return to normal life fast.

The average stay in hospital has reduced to 48-72 hours and the patient can return to normal life within two weeks of the surgery.

The cost of these kidney stone surgeries is generally less than one lakh rupees and the loss of work due to rest at home is also minimum.

So be healthy and have perfect kidney health,

Dr Avishek Mukherjee MS MCH

Head urosurgeon and transplant and uro-cancer surgeon

NKPC Kidney clinic