Removing kidney stones by crushing and laser treatment. A kidney stone is a deposit of a large number of small crystals formed in the urine (in the kidneys). The urine contains all kinds of waste products that need to be excreted, such as excess salts, toxic substances and other waste products. When these substances precipitate in the kidney and form crystals, kidney stones can form. Small kidney stones can leave the kidney and possibly be excreted naturally through the urinary tract. Larger stones can be in the renal pelvis and in the ureter (the connecting tube between the kidneys and the bladder). A larger kidney stone may require surgery.
- Removing kidney stones through surgery
- Crushing or surgery
- ‘Open’ surgery is almost no longer necessary
- Crushing Kidney Stones: Extracorporeal Shock Wave Lithotrypsy
- Kidney stone crusher
- Larger kidney stones
- Laser kidney stones: Ureterorenoscopy with laser technique
- Percutaneous nephrolitholapaxia
- Removal of the stone through the skin
- Reducing the size of the kidney stone with a laser
- Open surgical operation
- Bloody urine after the procedure
Removing kidney stones through surgery
Kidney stone in the kidney / Source: Blausen.com, Wikimedia Commons (CC BY-3.0)” onclick=”openImage(this);”> Kidney stone in the kidney / Source : Blausen.com, Wikimedia Commons (CC BY-3.0)
Crushing or surgery
A larger kidney stone in the kidneys or in the ureter may require intervention in which the stone is crushed and/or removed by surgery. The procedure in which the stone is crushed with a kidney stone crusher (see image at the top of the article) is also called Extracorporeal Shock Wave Lithotrypsy (ESWL). This is the most common treatment.
‘Open’ surgery is almost no longer necessary
In earlier times, stones were removed by an ‘open’ operation via the abdomen or flank, during which the kidney or ureter was accessed to cut out the stone. Nowadays, only in rare cases is open surgery required to remove the stone. Due to major medical-technical developments, it is now possible in almost all cases to approach stones via the urinary tract. This can be done in different ways and depends on where the stone is located. The operation in which the surgeon ascends through the bladder and ureter to pulverize the stone with a laser is called ureterorenoscopy with laser technique . The method in which the surgeon punctures the kidney with a needle through the flank and removes the stone through an inserted hollow tube using special instruments is called percutaneous nephrolitholapaxia (PNL).
Crushing kidney stones: Extracorporeal Shock Wave Lithotrypsy
Kidney stone crusher
Treatment with the kidney stone crusher is called Extracorporeal Shock Wave Lithotrypsy (abbreviated ESWL) and takes place on an outpatient basis. The kidney stone crusher is a device that generates energy through shock waves. The energy is concentrated at the location of the stone and guided to the stone by targeted shock waves via a rubber ball. This crushes or pulverizes the stone into small fragments. The grit can be urinated out naturally; sometimes this takes several days. The shock waves pose no danger to the surrounding tissue. Because the treatment is not painless, painkillers are administered. In the days after treatment you may find blood in the urine. If the complaints persist, the treatment can be repeated.
Crushing kidney stones / Source: Tsester, Wikimedia Commons (CC0)
Larger kidney stones
The kidney stone pulverizer is less suitable for very large, very hard or soft stones, the kidney stone pulverizer is less suitable and a different treatment will be recommended (see below).
Laser kidney stones: Ureterorenoscopy with laser technique
During ureterorenoscopy (URS) with laser technology, the doctor inserts a thin hollow tube, called a ureterorenoscope , via the urethra and bladder into the ureter or (if the stone is in the kidney) into the renal pelvis. The stone is then removed using special instruments (plier and safety net) that are extremely flexible. If the stone is too large, it will first be pulverized using laser technology and then removed. All places in the kidney can be reached with the flexible instruments. The chance of success with this treatment is quite high. You usually stay in the hospital for a day and a night. The procedure normally takes place under anesthesia. Afterwards, you will temporarily have a catheter placed in the bladder to flush out any blood clots and debris from crushed kidney stones from the bladder.
Removal of the stone through the skin
With Percutaneous NephroLitholapaxia (PNL), the stone is removed using a specific surgical technique through a small hole in the skin and the relevant kidney. Percutaneous means ‘through the skin’. With this method, the kidney is punctured through the skin using a needle. A hollow tube is then inserted into the kidney and through this tube the kidney stone can be removed using special instruments. This tube only has a diameter of about one centimeter. The operation takes place under anesthesia. PNL is especially indicated for large or difficult-to-reach stones located in the kidney or ureter.
Reducing the size of the kidney stone with a laser
If the stone is larger than the diameter of the tube, the kidney stone will first have to be reduced in size with a laser, after which the kidney stone particles can be removed. The urine is usually bloody after the procedure. Therefore, after removal of the stone, the hollow tube is replaced by a renal catheter, a so-called nephrostomy catheter , and the urine is drained through this tube. With a stone that fills a large part of the collecting system in the kidney. (a so-called casting stone ), the complete stone often cannot be removed in one go. Any remaining stones can then be reduced in size using a kidney stone crusher (see above). After this treatment, the particles can be urinated out. Occasionally a second percutaneous treatment is indicated.
Open surgical operation
Sometimes the doctor is unable to puncture the kidney properly and cannot reach the stone. An open surgical operation may then be necessary to remove the stone. During an open surgical operation, the kidney is exposed and the (surgical) wound is much larger than with PNL.
Bloody urine after the procedure
After the procedure, the urine may be somewhat bloody and you may still excrete some residual stones or grit. This may be accompanied by excruciating pain. The first week after the procedure you may experience a burning sensation when urinating, somewhat comparable to a bladder infection.
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