Procedures For Kidney Stone Removal - An Overview




What are kidney stones? 


Kidney stones, as the name itself suggests, are stones that form in the kidneys and can be as tiny as a speck of dust, or as big as the size of a tennis ball. Apart from the kidneys, the stones can also form anywhere along the urinary tract which includes the ureter, bladder, and urethra. 

After your body absorbs the nutrition it needs, the remaining waste products travel through the bloodstream to the kidneys. The waste products get removed from your body through urine. When there is too much of waste and too less liquid in the urine, crystals begin to form which stick together and form solid masses or kidney stones.


The common symptoms of kidney stones include:

  • Foul smelling urine
  • Discoloured urine: pink, red, brown urine or blood in the urine
  • Frequent and urgent need to urinate
  • Fever and chills
  • Nausea and vomiting
  • Shifting pain in the lower abdomen and groin
  • Varying intensity of pain that comes and goes



Although the exact causes leading to the formation of the stones have not been established yet, a number of factors have been identified which increases the risk of kidney stones.


Risk factors for kidney stones include:

  • Inadequate consumption of water
  • A family history of kidney stones
  • Being bed-bound due to illness
  • Sedentary lifestyle
  • Obesity
  • Suffering from frequent urinary and kidney infections
  • Eating a high-protein diet and low-fiber diet
  • Consumption of excessive sodium (salt)
  • Active medical conditions such as Crohn's disease, gout, renal tubular acidosis, hyperparathyroidism, medullary sponge kidney, type 2 diabetes, and Dent's disease
  • Excessive consumption of supplements such as calcium and vitamin C


What are the types of kidney stones?


There are four main types of kidney stones:

  • Calcium Stones: Calcium stones are the most common form of kidney stones. They are formed when there is too much calcium in the urine. They may form due to an overactive parathyroid gland, an inherited condition called hypercalciuria, kidney disease, some cancers, or a condition called sarcoidosis.
  • Struvite Stones: These are horn-shaped and can grow quite large. They are usually caused by urinary tract infection.
  • Uric Acid Stones: Uric acid stones are softer than other types of kidney stones. They may occur due to a high-protein low-fibre diet. Patients suffering from gout are found to be at a higher risk to get uric acid stones.
  • Cystine Stones: They are caused by a rare hereditary disorder called cystinuria. Cystine stones are larger than other forms of kidney stones and tend to recur.

In about 85% of the cases, small kidney stones (<5 mm) pass out in the urine without medical intervention. Stones bigger than 5 mm may require medical intervention. Stones as small as 2 mm have been known to cause discomforting symptoms.


What kind of a doctor should I consult for kidney stone removal?


If you experience any of the aforementioned symptoms of kidney stones, you should immediately consult your family doctor or a general physician, who in turn may refer you to a urologist if a kidney stone is suspected.


How are kidney stones diagnosed?


After getting to know your symptoms, medical history and after a complete examination, the urologist will suggest tests to confirm the diagnosis of kidney stones. The tests may include:

  • A computerized tomography (CT) scan – where a computerized low-intensity X-Ray images are taken from different angles and analyzed.  


  • X-ray - which uses a low dose of electromagnetic radiation to accurately create images of the internal structures of your body. Radiolucent stones such as Cystine or uric acid stones may not be identified with this test.
     
  • Ultrasound scan: Images of the internal structures of your body are recreated using high-frequency sound waves.


  • Intravenous urogram (IVU) or intravenous pyelogram (IVP): In this procedure, a radio-opaque dye is injected through a vein in your arm. This dye highlights the presence of the stones on an X-ray. The dye later passes out of your body in the urine. It is advised that you inform the doctor about all your current medicines and allergies before undergoing this procedure. Before administering the dye though, your urologist will make sure that you are not allergic to it.



What are the kidney stone removal procedures? 


The following treatments and procedures are available to manage kidney stones: 


  • Diet: Your doctor/dietician may prescribe you with a modified diet.


  • Medications: Your doctor may prescribe medicines which can dissolve certain types of kidney stones. (ex. kidney stones formed of calcium or uric acid can be treated with medicines.)
    Other medicines are also prescribed to relieve the symptoms of kidney stones which include:

    • pain medicines
    • muscles relaxants which assist the stones to pass through
    • antibiotics to manage any infection
    • Other medications to manage the underlying disease that is causing the kidney stone




What is the cost, anesthesia type administered, and the success rate of each kidney stone removal procedures? 



To know the description, cost, anesthesia type administered, and success rate of each kidney stone removal procedure please refer to the comparative kidney stone procedures table below: 


                                 

Differentiating Factors 



Lithotripsy 

Percutaneous Nephrolithotomy 

Percutaneous Nephrolithotripsy 

Ureteroscopy 

Open Surgery 

Description 

Shockwaves are used to break up the stones in the kidney, bladder, or the ureter.

A small puncture (approx. 1 cm) is made through the skin of your back. A hollow tube is inserted into the kidney with a probe through the tube. The doctor removes the stone through the tube.

In Nephrolithotripsy the stones are broken into fragments and then removed.

A small flexible camera is inserted into the kidney and the ureter. An instrument with a "basket" or a laser fiber is used to break the stone to fragments.

An incision is made on your side or abdomen, and the kidney or ureter is opened to remove the stones.

Cost 

Cost of general ESWL process ranges between 

- Rs.15000 to Rs.35000 depending on the size of the stones.

Laser and holmium lithotripsy procedures 

range between

 - Rs.50000 to Rs.80000 depending on the size of the stones.

Ranges between Rs.75000 to Rs.110000 depending on the size of the stones.


Ranges between Rs. 40000 to Rs. 70000.

Anesthesia Type 

Depending on technique, the type of stone and the medical condition of the patient, local, regional, or general anesthesia is used.

General anesthesia


Success Rate

High success rate of above 90%. Though, repeated sessions may be required. 

High success rate for very large stones. Success rate for an initial PCNL procedure is approximately 80-90% with the rate going up between 90-100% after a second PCNL procedure.

High success rate for very large stones. Success rate for an initial PCL procedure is approximately 80%-90% with the rate going up between 90%-100% after a second PCL procedure.

Ureteroscopy has the highest success rate, i.e., 95% for small to medium stones.

50 - 90% success rate, depending on the location of the stone, the patient’s overall health condition, and and the surgeon's technique and experience.


      



What is the recovery time and the time taken to perform each of the kidney stone removal procedures? Is hospitalization required for all procedures? 



To know the time taken to perform each procedure, the recovery time, and whether it is an inpatient or an outpatient procedure please see the comparative kidney stone procedures table below:

 



Differentiating Factors 


Lithotripsy 

Percutaneous Nephrolithotomy 

Percutaneous Nephrolithotripsy 

Ureteroscopy 

Open Surgery 

Time Taken for Procedure 

45 mins – 1 hour

2 - 3 hours

1 – 2 hours

1 hour

2.5 hours

Recovery Time 

Complete recovery can take up to 2 weeks.  

Can resume work after 2 days.

Complete recovery takes around 6 weeks, sometimes more, depending on patient’s condition. 

Can resume work after 1- 4 weeks depending upon the severity of the condition. 

Complete recovery can take 2 -4 weeks. Can resume work after 1 week.

Complete recovery can take 15 days. Can resume work after 1 week.

Complete recovery can take from 6-10 weeks. 

Inpatient/Outpatient

Depending on technique, the type of stone and the medical condition of the patient, it can be an inpatient or an outpatient procedure. If inpatient, it may require 2 – 3 days of hospitalization. 

Inpatient. 2-4 hospitalization depending on patient’s condition.

Inpatient. 2-3 days hospitalization depending on patient’s condition.

Outpatient

Inpatient. May require hospitalization for 7 to 9 days depending on the patient’s condition. 






 

What is the eligibility criteria for the kidney stone procedures? 



To know the eligibility criteria of each of the kidney stone procedures please refer to the table below:



Differentiating Factors 

Lithotripsy 

Percutaneous Nephrolithotomy 

Percutaneous Nephrolithotripsy 

Ureteroscopy 

Open Surgery 

Eligible Candidates

Patients with:

- small kidney stones (generally smaller than 2 cm) easily seen in an X-Ray

- stones in the upper portion of the ureter


Patients: 

- with kidney stones larger than 2 cms in diameter
- a history of serious infection, smaller kidney stones can be treated with this procedure

- with a malformed kidney

who did not benefit by undergoing lithotripsy procedure or cannot be effectively treated by ureteroscopy (in case of patients who opt for Percutaneous Nephrolithotomy)   

-  who did not benefit by undergoing ureteroscopy or are not eligible for lithotomy (in case of patients who opt for Percutaneous Nephrolithotripsy)





Patients: 

- with kidney stones smaller than 2 cms

- who are pregnant women

- who are overweight

- who suffer from blood-clotting problems


Patients: 

- with very large stones and with severe symptoms.

- who are ineligible for less invasive procedures.

- who suffer from kidney damage and bleeding caused by the stones.

-  in whom the size of the stone keeps growing larger.

- who are obese 

-  suffer from skeletal deformity or comorbid medical disease.





To know ineligibilty criteria for the kidney stone procedures please refer to the table below: 




Differentiating Factors 

Lithotripsy 

Percutaneous Nephrolithotomy 

Percutaneous Nephrolithotripsy 

Ureteroscopy 

Open Surgery 

Ineligible Candidates

Patients:

- with active urinary infection

- who take blood thinners

- with obstructed kidneys

- whose kidney stones composition includes cystine and certain types of calcium phosphate stones, as these stones do not break easily with lithotripsy

- suffering from ongoing urinary infection  

- are pregnant


Patients:

- with damaged kidney

-who are obese

-who take blood thinners

- suffering from ongoing urinary infection  

Patients:

- with kidney stones larger than 20 mm

- who have undergone ureteral or bladder reconstruction

- who are intolerant to stents.

- suffering from ongoing urinary infection  


Patients: 

- are pregnant  

- are pregnant
 

- who take blood thinners 

- who suffer from uncontrolled diabetes 

- suffering from ongoing urinary infection  





 

What are the common side effects of the kidney stone procedures?

 


Please refer to the comparative table below for the most common side effects of kidney stone removal procedures: 

   

Differentiating Factors 


Lithotripsy 

Percutaneous Nephrolithotomy 

Percutaneous Nephrolithotripsy 

Ureteroscopy 

Open Surgery 

Pain  

Minimal

Yes

Minimal

Yes


Bleeding 

Minimal

Yes

Infection

Can be prevented with post-operative care


 

More Topics on Kidney Stone Removal 

People interested in this topic also read: 

 

References


1. Madhy S. Agrawal H. Management of multiple/staghorn kidney stones: Open surgery versus PCNL (with or without ESWL). PubMed Central (PMC). 2018.  Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2710093/. Accessed March 5, 2018.

2. Aboumarzouk O, Kata S, Keeley F, McClinton S, Nabi G. People who undergo ureteroscopy for the treatment of stones achieve a higher stoneā€free rate but have more complications and longer hospital stay. 2018. Available at: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013680/. Accessed March 5, 2018.

3. Zengin K, Tanik S, Karakoyunlu N et al. Retrograde Intrarenal Surgery versus Percutaneous Lithotripsy to Treat Renal Stones 2-3 cm in Diameter. 2018. Available at: https://www.hindawi.com/journals/bmri/2015/914231/. Accessed March 5, 2018.

4. Reddy S, Shaik A. Outcome and complications of percutaneous nephrolithotomy as primary versus secondary procedure for renal calculi. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871386/. Accessed March 5, 2018.

5. Younesi Rostami M, Taghipour-Gorgikolai M, Sharifian R. Treatment of Kidney Stones Using Extracorporeal Shock Wave Lithotripsy (ESWL) and Double-J Stent in Infants. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3329132/. Accessed March 5, 2018. 

 

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Percutaneous nephrolithotomy is an inpatient invasive procedure in which the surgeon removes the kidney stone(s) through a small incision in the skin.

Ureteroscopy: Meaning, Procedure, and Cost

Ureteroscopy is a minimally invasive method of treating kidney stones, ureteroscopy is an endoscopic procedure, which helps the urologist to view the inside of your ureter. An instrument called ureteroscope is used for this purpose.

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