Kidney stones or urolithiasis is one of the most common urological disease and the demand for effective processes for kidney stones treatment, is a problem, concerning medicine for centuries.
Thanks to enormous technical progress and development of new laser and bloodless methods, modern kidney stones treatment took on a whole different look. We already have out-body whipping, lasers and optical systems that allow us to reach out to the stone without having to operate the patient. However, that a variety of methods puts us before a serious matter which particular method would be the most effective and suitable for the particular stone and patient.
What determines the choice of kidney stones treatment?
The main factors that determine the choice of method are the size of the stone, its location (in the kidney or ureter) and the condition of the kidney, ie whether it is blocked or not.
Choice of treatment for small stones (1-1.5 cm) is no longer much of a problem, since approximately 90% of cases they break the so-calledextracorporeal shock wave lithotripsy (SWL). It uses shock waves which under X-ray control focus on stone and destroyed it.
The significant advantage of this method is that the procedure is virtually non-invasive, painless, rarely lasts more than half an hour, and in most cases the patient is ready to return to daily activities immediately after that. But along with the undoubted advantages this method has limitations, mainly depending on the size of concretion and the rate of failure significantly increases with large stones over 2 cm.
So the question of the treatment of bigger kidney stones is still open and discussable.
For these patients, there are two other methods, which even called “bloodless” still are invasive and require the use of anesthesia, as well as a hospital stay. These are Retrograde intrarenal surgery (RIRS) and Percutaneous nephrolithotripsy (PNL).
Retrograde intrarenal surgery (RIRS)
This is contemporary and bloodless method of treatment which uses natural holes and channels in the human body – a trend which modern medicine is developing at great speed not only in urology but also in many other disciplines – surgery, gastroenterology, invasive cardiology , neurosurgery and others. This method involves inserting a thin instrument (ureteroscopes) through the bladder and the ureter, down to the kidney. Besides fiber optic camera and light source on them is pumped laser probe. With its help an power is provided that breaks gallstones.
There are two types of ureteroscopy – rigid (hard) and flexible (folding, soft). Ureteroscopy with laser break represents the “gold standard” in the treatment of gallstones in the ureter. For kidney stones there are used flexible ureteroscopes. Their end is mobile, flexible and direction of bending is undert control of the urologist. This makes it possible to reach concretions in the cups of the kidney that are often inaccessible for extracorporeal lithotripsy. After the disintegration of the stone and elimination of fragments, practically the operation ends. In total cases after leaving anesthesia the patient is most often ready to return to normal life. Despite the obvious advantages, and this method has some limitations due to the slow disintegration of the stones because of small laser probes on the one hand, and on the other hand – to the difficulty of elimination of the fragments due to the small diameter of the tool itself. These shortcomings make work on gallstones larger than 2-2.5 cm very difficult.
Percutaneous nephrolithotripsy (PNL)
Percutaneous nephrolithotripsy (PNL) represents a procedure in which through a small incision in the skin (about 1 cm) it is placed a tube which is used for direct access to the kidney. In it, it is inserted a tool like ureteroscope which has a light source, camera and enrgien source. Unlike the ureteroscope, however, here it is possible to work faster and at the same time it is easy to eliminate fragments because it works with larger diameter instruments. This allows you to work even in stones with a diameter of more than 4 cm 3, which until recently were treated with open surgery.
The method is surgical, which means that there is some risk of complications such as bleeding and infections, but if we compare it with open operations virtually the risk is incomparably lower. Usually the hospital stay is 3-4 days. After the surgery a small tube remains that is removed after a few days. The method is considered the standard for concrements bigger than 2 cm, located in the kidney.
For large, multiple stones it is possible to use a combination of two accesses – by ureteroscopy and percutaneous nephrolithotripsy simultaneously. Both methods in recent years have replaced 95% of open surgery for the treatment of urolithiasis.
As a final of the article, we will say that the kidney stones treatment is a complex and still there isn’t a universal method because as seen here, each of the above mentioned has its advantages, but also disadvantages. Choice of method depends to a large extent on the size of the stone, available equipment and of course the personal preferences of the patient.