Urinary Stone Treatment
Urinary stones are formed in the kidney from a combination of factors, like insufficient water intake, high carbohydrate-low fibre diet, excess oxalates intake (tea, chocolates) and high purine foods (peanuts, red meat, soya beans, beer).
Most stones present with colicky loin to groin pain which is so painful that strong narcotic injections are invariably needed. This pain is due to the high pressures created in the blocked kidney as the stone passes down. There is usually blood in the urine too due to ‘abrasion’ of the urinary tract lining. Prolonged blockage will lead to infection, especially in diabetics. If infection occurs, fever, persistent loin pain and painful, frequent urination develops. If the obstruction is prolonged, the kidney is at risk of permanent damage (atrophy).
1. ESWL (Shock wave lithotripsy)
A lithotripter is a machine that stones into tiny pieces using the technology of focused shock waves. The stone is located by means of xray or ultrasound attached to the machine. This is a safe outpatient treatment lasting about 1 hour. It can be used to treat stones lodged in the kidney or ureter, the highest success rate being for kidney stones (> 90%)
2. PCNL (Endoscopic puncture through the kidney)
This is a minimally-invasive technique for stones > 2 cm located in the kidney or upper ureter. It involves creating a puncture tract into the kidney to access the stone by means of a nephroscope. The stone is broken either with a laser, ultrasonic or pneumatic device and extracted out via this scope. The whole procedure is done under xray guidance and takes between 2 to 3 hours to do. Despite the surgical risks, the advantage of PCNL over ESWL is that big stones can be cleared with a high success rate (>95%) at a single session.
3. URS (Endoscopic treatment via the ureter)
This endoscopic procedure involves a mini-scope that is passed up the urethra into the bladder and up the ureter. It is suitable for stones < 1 cm lodged in the ureter. A laser or pneumatic probe is placed onto the stone to break it. A wired basket can also be used to extract the stone pieces. The procedure takes 30 mins to 1 hour and can be done as a day case because the pain and bleeding is usually minor. Some cases may require a double-J stent to be inserted into the kidney especially if injury has occurred to the ureter wall. URS is ideal for stones lodged in the lower ureter ( success rate > 95%).