The 4 methods of kidney stone removal

4 Methods for Kidney Stone Removal

Kidney stones are pesky in nature. They typically cause a pain that is frequently described patients as the “worst pain ever felt in there lives”. This pain also radiates from the sides all the way to the groin and abdomen. Sometimes, you may feel the pain to be increasing in intensity and occurring in waves. However, the story does not end there.

Kidney stones can also cause other symptoms like burning pain while passing urine, fever and the sensation of ‘wanting to throw up”. In the most worst case scenario, if you do not get a kidney stone removal treatment, you may end up chronic kidney disease. Sometimes, a very large stone that is untreated can also result in renal failure as well.

Thus, it becomes extremely crucial to get a diagnosed kidney stone removed as it is a medical emergency and also since there is a real risk of long-term kidney damage.

At a global level urologists usually employ 4 methods of kidney stone removal that are well accepted and quite popular.

The first method is the conventional medical management of kidney stone removal without a surgery.

1. In this technique, your urologist or primary care physician will medically assess for symptoms of kidney stone.
2. The next step is blood tests, urine tests and appropriate diagnostic imaging. Commonly prescribed imaging studies for diagnosing a kidney stone include Ultrasound imaging and non-contrast-enhanced CT. X-Ray may be used, but has fallen out of favour since CT and ultrasound both have over 80% accuracy in picking up a stone. X-ray, however, can help in finding out whether is stone is a calcium-based due to its appearance…

In general, kidney stones may present with a variety of different chemical compositions and different sizes that require different treatment approaches.

Both the size and the position of the kidney stone ultimately decide the future course of treatment.

For example, if you have a stone that is present in the lower pole of the kidney and if the size is greater than 2 cm, medical therapy is pretty much useless. On the hand, a small stone that is less than 5 mm in size somewhere in the upper or middle pole of the kidney may pass out with medical expulsive therapy.

Common drugs that well researched in removing such stones include Tamsulosin and calcium channel blockers. Stone expulsion may happen in 4 to 8 weeks and is due follow up is done by your consultant. Painkillers are also usually given to reduce the pain in general.

Can water dissolve kidney stones?

Not necessarily.

While you may maintain adequate hydration by taking adequate fluid intake, excess water though may lead to more harm than good. In some patients, excess drinking of water has led to worsening of kidney stone pain and other complications. Always, remember to consult your doctor before taking a hasty decision on self-treating a stone. As the old saying goes…’haste makes waste’

Most urologists who operate and remove kidney stone prefer either one of the following surgical approached to removing a stone. They are:

1. Shockwave Lithotripsy (SWL)
2. Uterescopic Stone Fragmentation
3. Percutaneous Nephrolithotomy

This technique which is widely used world over, involves the use of sound waves to break the stone. Here, high energy acoustic waves are targeted on the calculus (stone) with the help of a lens. Since the waves carry energy, the stones are disrupted internally. To precisely locate the stone, ultrasound guidance is also used. This method has a success rate ranging from 50 to 80 percent and is best used for stones located in the upper pole and middle pole of the kidney. This method also works best when the stone size is less than 2 cm in general.

A patient can be declared stone free if his imaging study done after 90 days show no kidney stones. The SWL, however, is not a preferred method of stone retrieval when stone size is greater than 1 cm and if the stone is in the lower pole of the kidney. The other pitfall of the procedure is that this method cannot be used efficiently in patients who are obese. However, the quality of life scores and patient recovery after this procedure is excellent. Postoperative complications are also extremely minimal in nature.

Ureteroscopy is a fairly non-invasive procedure that achieves excellent stone removal rates. Here what is simply done is that a flexible endoscope to visualize the stone is passed up into the ureter, then using laser fiber (Ho-YAG laser), the stone is vaporized.

This laser treatment of kidney stones is done in most developed countries. At the laser kidney stone clinic, T-Nagar and OMR,  we prefer this methodology of stone removal compared to SWL due to its lower complication and higher success rates. Moreover, with this technique, the risk of stone recurrence is much lower compared to SWL.

However, an important point to note here is that even this method may not work if the stone is very large i.e greater than 2 cm and if located in the lower pole of the kidney. Studies conducted of 1000’s of patients have clearly shown that laser-based ureteroscopic stone removal is equal to if not better than SWL. As with SWL, laser-based ureteroscopic stone removal also requires appropriate sedation and anesthesia.

Interestingly, studies have found that ureteroscopic stone retrieval is the preferred method of kidney stone removal in patients where there is obesity, kidney infection and also in patients were stone visibility is poor in a conventional X-Ray. The Ho-YAG laser tech also seems to have the ability to fragment all different stone compositions and stone types.

This technique is also called as the PCNL technique, were the kidney is directly accessed through the skin with the patient is lying down position. Over 70% of all PCNL procedure is done only for stones in the lower pole of the kidney. This surgical method is also the methodology of choice when a kidney stone is greater than 2 cm in size.

PCNL is a more invasive procedure in general and there is  2% risk of sepsis and 5% risk of having a blood transfusion. However were a kidney stone is branched or the stone is very large, PCNL is deemed to be a necessary procedure with stone removal rates of over 80% to 90%. Furthermore, the length of hospitalization after a PCNL procedure may also be more compared to SWL and laser-based stone removal.

Well, I completely understand your concern, so now let us explore a bit more about kidney stone surgery complications.  As far as Shock wave lithotripsy is concerned, the biggest issue is that, sometimes stone dissolution may not take place in 100% of all attempts. As previously described, this procedure is not good enough if you have a stone in the lower pole of your kidney and if the size of your stone is more than 1 cm. Furthermore, when the patient is obese, re-treatments may be required since in these patients visualizing kidney stone or approaching it itself would have complications.

This SWL technique may not work for stone composition types too. Especially those that are dense in nature. However, this technique has an excellent patient recovery with a less than 1% risk of sepsis or bleeding post the procedure.

Moving on to ureteroscopy combined with laser, this technique is more efficient in removing most stones compared to SWL. This technique as previously described also works for different stone types.

Getting a laser treatment for kidney stone removal requires considerable expertise from your treating consultant. If done right, recovery and complications are even lesser than the SWL procedure.

PCNL on the other hand, is always a last resort option and is reserved only for really large and pesky stones! PCNL is definitely associated with a few complications and requires post procedure admission and bed rest.

Truth be told. Prevention is always better than cure, and we are big fans of this very philosophy!

“An Ounce of prevention is worth a pound of cure” – This saying particularly applies to kidney stone treatment.

Numerous studies have suggested that your dietary habits can significantly influence the stone formation and stone composition. This is especially true in calcium oxalate based kidney stones. Here are some quick tips that can help in preventing or removing kidney stones naturally especially when you have a calcium stone.

1. Increase water intake by at least one liter per day, add another 500 ml in summer months
2. Reduce the dietary intake of calcium to less than 1000 mg/day
3. Reduce sodium intake to <2 g/day which is roughly 5g of table salt in general
4. Reduce meat and junk food intake
5. Strictly avoid all types of soda-based beverages
6. Lastly, increase vegetable intake and fiber intake in general

Consistently and sincerely following all the aforementioned treatment strategies, will definitely help in kidney stone removal naturally. I hope this article shed some light on your understanding about removing kidney stones. Do feel free to contact us below for anything and everything related to kidney stones. We are working towards our dream of being the best kidney stone hospital in Chennai.

References:

1. Khan SR, Pearle MS, Robertson WG, Gambaro G, Canales BK, Doizi S, Traxer O, Tiselius HG. Kidney stones. Nature Reviews Disease Primers. 2017 Jan 12;3:17001.
2. Ferraro PM, Taylor EN, Gambaro G, Curhan GC. Dietary and lifestyle risk factors associated with incident kidney stones in men and women. The Journal of urology. 2017 Oct 1;198(4):858-63.