Having kidney stones can be the most painful illness that one can have. The stones cause blockage and damage in the urinary tract resulting to excruciating pain. While some may feel the urgency to receive immediate medical attention, some will have small stones that can be passed naturally during urination. The size and location of the stone is often the determinant factor in the type of treatment necessary.
Types of Kidney Stone Treatment
Extracorporeal Shock Wave Lithotripsy (ESWL)
This is the most common and least painful kidney stone treatment available today. Before performing the procedure, imaging tests, such as x-ray or ultrasound, will be used to determine the location of the stone or stones. Shock waves are then applied on the area using a machine in order to break down the stone. Smaller stones can then pass on the urine naturally. The procedure can last 45-60 minutes and will require only mild anaesthesia. It is effective even for stones of up to 20mm in diameter.
Ureteroscopy (also known as Retrograde Intrarenal Surgery)
When a kidney stone is stuck in the ureter, which is the tube connecting the kidneys and the bladder, ureteroscopy is often done. The surgeon will use an ureteroscope (a long, thin telescope) will be inserted through the urethra, to the bladder and then through the ureter towards the location of the stone. Using another instrument, the surgeon will gently remove the stone. An alternative is to use a laser to break down the stone into smaller pieces so they can be passed in in the urine. This procedure requires general anaesthesia to successfully remove stones the size of up to 15mm in diameter. A stent is often inserted and left in the urinary tract temporarily for the stone fragments to pass into the bladder.
Percutaneous Nephrolithotomy (PCNL)
When kidney stones are 21-30mm in diameter, PCNL may be necessary. It is also often called for when a patient cannot receive ESWL due to obesity. In this procedure, a small incision is made in the patient’s back and a nephroscope (thin telescopic instrument) is passed through the incision and into the kidney. When the stone is reached, there are two options: the stone is pulled out or it is broken into smaller pieces using a laser for the fragments to pass in the urine. During the procedure, the patient would be under general anaesthetic.
When all of the above do not work, or are not possible, an open surgery is done. These days, it is rare for surgeons to perform an open surgery in kidney stone patients. The procedure is necessary in case of very large stones or an abnormal anatomy. An incision is made in the back to gain access to the ureter and the kidney and the stone is removed.
Uric Acid Stone Treatment
For uric acid stones, doctors would usually prescribe medication to dissolve the stone. Since uric acid stones are softer than the other types of kidney stones, a patient will often be advised to drink up to 3 liters of fluids, preferably water, on a daily basis and take medication to make urine more alkaline.
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