Urinary stones are a known problem since ancient times and represent an issue during the life of a percentage of the population. The majority of the people experience urinary stones as pain called renal colic. This particular pain associated with the presence of stones in the kidney or ureter. The stones of the kidney are a unique urologic problem because of significant complications other than pain that could potentially threaten patient’s life. In particular, the presence of large stones in the kidney can lead to chronic renal failure and the development of severe urinary tract infection and urosepsis.
Important parameters in the management of ureteral stones are the size, number of stones and their composition. Stones measuring more than 2 cm have a direct indication for percutaneous nephrolithotripsy while smaller stones can be treated with oral dose formulations (depending on their composition) and extracorporeal shock wave lithotripsy.
The stones of the kidney in addition to conservative monitoring, can be addressed in different ways according to specific indications:
⇒ Extracorporeal shock wave lithotripsy: The majority of patients have an indication for extracorporeal lithotripsy. But the success of the method depends on many factors including the size, location, composition and hardness of the stone. In addition, patient’s body type plays an important role (i.e obesity). During extracorporeal lithotripsy, the patient lies on a device called Lithotripter. Fluoroscopy is used to recognize and target the stone. Ultrasonic waves are emitted from the device and fragment the stone. Therefore, the above procedure is minimally invasive.
⇒ Percutaneous lithotripsy: This method is performed by percutaneous puncture of the kidney under fluoroscopic guidance, introduction of special endoscopic wires and placement of a special sheath that provides a channel between the skin and kidneys. Through this channel a tool called nephroscope is introduced, the stone is recognized and disintegrated by the use of ultrasonic lithotripter. The fragments are removed with the aid of an endoscopic forceps.
It is worth noting that there are two types of nephroscope, the rigid and the flexible nephroscope. The above instruments method provide solution to renal lithiasis with minimal burden on the health of the patient and treat successfully even large stones that occupy the entire cavity of the kidney drainage (staghorn stones). Renal stones that have failed conservative or extracorporeal lithotripsy treatment have also indication for percutaneous nephrolithotripsy. Practically, all kidney stones can be treated with this method.
• Postoperative course
The patient is dismissed from the hospital on the fourth day after the surgery. A nephrostomy tube remains in place for the above time period and removed the day of departure. The removal process takes 1 minute and is not painful.
Complications that might be encountered are bleeding, pneumothorax and infection leading to prolonged hospitalization.