Kidney stone or commonly referred to as renal calculi, is among the most common diseases affecting around 15% population in India. Renal calculi affect the functioning of kidneys and the urinary system in the body causing unbearable pain as they move along the urethral lining. The pain can be so severe that people often describe it as a sharp sensation of a knife being twisted around in the back. Urologists recommend kidney stone surgery to effectively remove stubborn stones that are otherwise immune to medications and other home remedies.
Surgical Procedures for Kidney Stones:
The surgical procedures for kidney stones involve the latest equipment for effective results and less recovery time. Urologists often distinguish the size and composition of stone using different diagnostic tests that help them decide the best course of the procedure. Let’s get into the details of each surgical procedure and its significance –
Extracorporeal Shock Wave Lithotripsy (ESWL) – This is a non-invasive surgical procedure where kidney stones (sized between 5mm to 8mm) are bombarded with precise external shockwaves. There is a viscous liquid medium present between the abdomen and the machine that breaks the stones into smaller pieces. The patient is administered spinal anesthesia to reduce the pain as the stones are flushed out of the body. ESWL is a conventional procedure that may require multiple sittings to break the stones completely.
Ureteroscopic Lithotripsy (URSL) – Ureteroscopic lithotripsy uses a medical device called a ureteroscope. A ureteroscope is a thin, flexible device attached to the camera and laser on the other end. The patient is administered with local or general anesthesia before the procedure for a pinless experience. URSL is an effective surgical method for moderately sized kidney stones (between 6mm to 10mm). The urologist locates and breaks the stones into smaller fragments which are flushed out through urine. The urologists may insert ureteral stents to ease the movement of stones during the expulsion.
Retrograde Intrarenal Surgery (RIRS) – RIRS is an advanced procedure to effectively treat kidney stones with sizes between 8mm to 15mm. The patient is first administered with either spinal or general anesthesia for a painless procedure. The doctor then inserts a thin, flexible endoscope attached to a tiny laser on the other end. The stones are subsequently broken into smaller fragments and flushed out through urine. The surgeon may choose to insert DJ stents to enlarge the passage of the urinary tract for smooth movement of stones. The surgeon removes the stents when the stones are thoroughly flushed out of the body.
Percutaneous Nephrolithotomy/Nephrolithotripsy (PCNL) – PCNL is a minimally invasive procedure to remove kidney stones of size greater than 14mm. It is also known as tunnel surgery due to small incisions near the flank area. The doctor administers anesthesia before the procedure for a painless experience. The surgeon then carefully uses a nephroscope to determine the location of the stones and break them into smaller pieces. If the stone is removed in its intact state, it is called nephrolithotomy, and if the stone is broken into smaller fragments, it is termed nephrolithotripsy.
When Do You Need Kidney Stone Removal Surgery?
Kidney stones vary in size being as small as a grain of sand or as large as a golf ball. Small stones that are usually less than 5mm may not necessarily require kidney stone surgery. Our ureter is around 3mm to 4mm wide, which allows only small stones to pass without causing major pain. Kidney stone doctors generally prescribe medications such as alpha-blockers, pain relievers, etc., to reduce the pain caused during the movement of stones as they are flushed out of the body.
Large stones are usually stubborn and require advanced kidney stone procedures. Urologists initially determine the size, number, and location of the stones to decide the best course of the treatment procedure. There are four techniques to remove kidney stones – Extracorporeal Shock Wave Lithotripsy (ESWL), Ureteroscopic lithotripsy (URSL), Retrograde Intrarenal Surgery (RIRS), and Percutaneous Nephrolithotomy/Nephrolithotripsy (PCNL). The duration of surgery varies depending on the type of procedure. However, all procedures are in daycare, which means the patient can go home within 24 hours of surgery after the doctor’s consultation. Let us dive deep into the domain of kidney stone removal surgeries for better understanding.
Recovery from Kidney Stone Surgery
While the different surgical procedures are very effective and cause instant relief from the pain and discomfort, the recovery time is almost as essential as the surgery itself. The recovery after kidney stones surgery usually depends on the health condition of the patient, the severity of the condition, and how strictly the patient follows post-recovery tips.
The patient can resume normal activities within 5-7 days. However, there may be some restrictions related to physical activities if the stents are not removed from the ureter. Your kidney stone doctor will give you a set of instructions after your operation for a smooth and quick recovery. Here are some recovery tips that can help reduce the pain and discomfort after the surgery –
- Take the prescribed medication regularly to reduce the pain after the surgery. Certain medications relax your ureteral muscles to allow the smooth movement of stones. If bleeding increases, consult with your doctor.
- There may be mild bleeding in the urine due to the presence of ureteral stents, which can subside within 2-3 days after the surgery. So make sure to not interfere with it and if in case you see it coming out, contact your doctor.
- Continue drinking enough fluid to keep yourself hydrated. It also helps flush out small fragments of stone that may have remained after the surgery.
- Your doctor may prescribe some antibiotics to prevent infections in the urine.
- Take adequate rest after the surgery. There may be some discomfort while sitting, but you can gradually increase the level of activities.
- Keep in contact with your doctor in case you feel any discomfort after the surgery.
Conclusion:
There are four main surgical procedures to remove kidney stones – percutaneous nephrolithotomy and nephrolithotripsy, ureteroscopy, shockwave lithotripsy, and intrarenal surgery. A kidney stone doctor may also recommend an open surgery in case of a complication or when all other procedures are ineffective. It is important to follow post-operative care for quick and smooth recovery. However, prevention is always better than cure, and so, a person should drink plenty of water in a day and make dietary changes if necessary.