Kidney stones are not always fatal, as they tend to
pass out from the body through urine. But surgery
has to be done if:
-Infection is present.
-The patient has intolerable frequent bouts of
severe pain.
-The patient is anuric (A condition in which there
is total absence of urine production)
-If there is Hydronephrosis (Aseptic dilatation of
the whole or part of the pelvicalyceal system of the
kidney due to partial or intermittent obstruction to
the outflow of urine)
-If there is Pyonephrosis (In this condition, kidney
is converted into a bag of pus)
The treatment of renal stones or calculi can be
divided into Non-Operative treatment and Operative
treatment.
Non-Operative Treatment.
1-Small stones less than 5mm in size pass off
with intake of copious amount of fluids and at times
forced diuresis. Intravenous hydration followed by
intravenous Frusemide may help pass the stones
spontaneously.
2-Extracorporeal Shock Wave Lithotripsy (ESWL)
In this procedure, after cystoscopy, a ureteric
stent (Double J Stent) is placed into the ureter on
the side of a lager renal stone. Shock waves are
generated (around 500-1500 shock waves) which blast
the stone, getting it crushed, so it comes out by
the side of stent.
ESWL has 3 advantages as this procedure does not
cause incision, nor pain and above all, it is quite
safe but its disadvantages are its cost factor and
availability.
Operative Treatment
1-Endoscopic Procedures
Percutaneous Nephrolithotomy (PCNL)
PCNL is often done when stone is quite large.
In this procedure, Retrograde Pyelography (RPG)
is done, stone is located in the pelvis of kidney.
With a small 1cm incision in the loin, the PCN
needle is passed into the pelvis of kidney and is
confirmed by fluoroscopy. A guide wire is passed
through the needle into the pelvis of kidney, now
the needle is withdrawn with the guide wire within
the pelvis. Over the guide wire, dilators are passed
and a working sheath is introduced into the pelvis.
A nephroscope is passed into the pelvis and if the
stone is small, it is taken out and if big, it may
have to be crushed using ultrasound probes and the
fragments are removed. Ultrasound or pneumatic
energy is used for fragmenting.
PCNL has its own complications as it may cause
injury to colon and blood vessels, may cause urinary
leak that may persist for few days and may cause
sepsis.
2-Open Procedures
Depending upon the location of the stone, various
types of procedures are done which are mentioned
below:
A. Pyelolithotomy
B. Nephrolithotomy
C. Extended Pyelolithotomy
D. Pyelonephrolithotomy
E. Partial Nephrectomy
F. Nephrectomy (This is done when kidney is
destroyed by pyonephrosis, following obstruction by
stone)
3-Special Procedures
A. Bilateral Renal Stones: Kidney with better
function has to be operated first. 1-2 weeks later,
the opposite side is operated.
B. If there is pyonephrosis with a severe degree of
fever, pain and tenderness, Nephrostomy is done. If
kidney is nonfunctioning, Nephrectomy is done but if
kidney is functioning ESWL/PCNL/Open Procedure is
done. This is known as Percutaneous Nephrostomy.
However, it must be kept in mind that open
procedures for management of stone disease have now
become obsolete.
