Kidney stones are mineral deposits formed in kidney. Many times such stones cause pain & discomfort & require treatment. If large enough or obstructing path of urine may cause kidney failure.

Symptoms

1. Severe pain in the back, side, or lower abdomen
2. Pain that comes and goes in waves
3. Pain that intensifies while urinating
4. Blood in the urine
5. Nausea and vomiting
6. Cloudy or foul-smelling urine
7. Fever or chills (which may indicate an infection)

Treatment-

If small, stones can be passed with adequate water intake & medicines. If larger, requires treatment as miniperc (miniPCNL) or RIRS (retrograde IntraRenal Surgery).

How miniPCNL is done?

Under anaesthesia, Small hole is made at back & small scope of size of roughly pencil is introduced into the kidney. Stone is visualized & broken with help of LASER & fragments retrieved. Complete clearance of stone is checked on xray machine during surgery itself. Patient is usually discharged in next 48 hours.

How RIRS is done?

Under anaesthesia a very small scope is used to access the kidney through the urethra and bladder, without making any incisions. LASER is used to make dust of stone which passes spontaneously through urine. Larger fragments are removed with small basket.

Both miniperc and RIRS are considered minimally invasive procedures, meaning they typically result in less pain, a shorter hospital stay, and a quicker recovery time compared to traditional open surgery. However, the choice of which procedure to use depends on the size, location, and type of kidney stone, as well as the patient’s overall health and medical history.

Ureteric stones

are the stones in ureter, the tube connecting kidney to bladder for passage of urine. These stones are usually formed in kidney & moved to ureter. The symptoms of ureteric stones can be similar to kidney stones but usually more intense even with less size as they cause obstruction of narrow path of urine.

symptoms:

1. Severe pain on one side of the lower back, abdomen, or groin
2. Pain that comes and goes in waves and can be accompanied by nausea and vomiting
3. Painful urination or a persistent urge to urinate
4. Blood in the urine
5. Difficulty passing urine or a reduced urine flow
6. Fever or chills, which may indicate an infection

Treatment-

Depending on size, location & symptoms ureteric stones require medical or surgical treatment.

Chances of stone passage with medical treatement are more if

1. Stone size < 5mm
2. Stone distal in ureter
3. No fever
4. Adequate water intake
5. Patient ready for regular followup

Surgery is required when ureteric stone does not pass with medical management or is not suitable for same.

1. Ureteroscopy (URS): under anaesthesia thin scope is passed through the urethral opening and bladder to ureter. LASER is then used to break up the stone into smaller pieces, which are removed using a small basket. Complete removal of stone is checked during surgery with xray. Usually double J stent, a thin plastic tube with one end in kidney & other end in bladder is kept. It helps in good healing of stone impaction area & drainage of kidney. It is removed in followup visit on outpatient basis.
2. Miniperc: miniperc is used for stones in upper part of ureter which are difficult to be removed by URS. Such stones are pushed to kidney & removed via small incision in back after breaking with laser.
3. RIRS: Alternative to miniperc, flexible ureteroscopy can be used to remove stone in upper part of ureter with help of laser. This prevents incision on back.

Bladder stones

They are hard, mineral deposits that form in the bladder.

symptoms

1. Pain or discomfort in the lower abdomen
2. Painful urination
3. Difficulty urinating or a weak urine stream
4. Blood in the urine
5. Urinary tract infections (UTIs)
6. Urinating more frequently than usual or feeling like you need to urinate even after urinating
7. Inability to urinate

Treatment options for bladder stones may include:

1. Medications: If the stone is small and likely to pass on its own, medications can be prescribed to help reduce pain and prevent infection.
2. Cystolitholapaxy: This is a minimally invasive procedure that involves inserting a small scope through the urethra and using a laser to break up the stone into smaller pieces, which can then be removed through the scope.
3. PCCL (percutaneous cystolithotripsy)- under anaesthesia, small incision is made on abdomen & scope introduced in bladder. Stone is broken with laser or pneumatic lithoclast & fragments removed. This surgery is used when stones are too large to be removed via urethra.
4. Open surgery: In rare cases where other treatments have been unsuccessful, open surgery may be necessary to remove the stone. This involves making a larger incision in the abdomen to access the bladder and remove the stone.

After surgery for bladder stones, urethral catheter is kept for 1-3 days which is then removed.