Endoscopic Renal Stone Surgery
Renal stones are one of the most common and most painful disorders of the urinary tract. A renal stone is a hard crystalline mineral material that forms within the kidney or urinary tract.
Most renal stones that are small enough usually pass through the urinary tract on their own with more fluid intake. Surgery may be needed to remove a renal stone if it does not pass after a reasonable period of time or if the stone is growing and blocking the flow of urine. Endoscopic surgery is a minimally invasive surgery performed using endoscope a specialized surgical instrument which is a thin, long, flexible tube with a camera and light attached to it that enables the surgeon to view inside the body. Various endoscopic surgeries performed to remove the renal stones include Cystoscopic, ureteroscopic and percutaneous endoscopic surgeries.
Cystoscope is a long, thin instrument attached with an eyepiece on the one end and a small lens with a light source at the other end which is inserted into the bladder. Cystoscope can be used to remove the stones located in bladder and urethra. The Cystoscope will have more channels for inserting the instruments used to remove the stones and perform other procedures.
The procedure is performed by inserting a special telescopic instrument called ureteroscope. Ureteroscope is long and thin compared to Cystoscope that can be used to view and perform surgeries beyond the bladder into ureters. Ureteroscope will be inserted through the urethra, into the bladder, and up through the ureter. Once the stone is located within the ureter, the surgeon removes the stone with the tiny basket attached to a thin wire which is inserted through the other channel in ureteroscope. Surgeon may also use laser energy to remove or break the stones located in the ureter or kidney that are up to 3 cm in diameter. This is called laser lithotripsy where pulses of intense laser light can be used to fragment the stone into smaller pieces which are then flushed out through the urinary passage. A small tube or stent may be left in the ureter for a few days to help urine flow. The holmium laser is the most effective laser for the treatment of urinary stones.
- Short hospital stay
- More effective in removing hard stones
- Removes stones from any location in ureter or kidney
- Effective in removing stones of all compositions
- Quick recovery and patients resume daily activities in one or two days
Possible complications following laser lithotripsy include, bleeding, infection, and tissue scarring.
Percutaneous Endoscopic Surgery
Percutaneous endoscopic surgery or percutaneous nephrolithotomy (PCNL) is a keyhole surgery for removal of kidney stones. During the procedure a tiny incision is made at the back through which a guided wire is passed into the kidney and a tunnel is created directly into the kidney. The procedure is performed under X-ray guidance. Using an instrument called a nephroscope the surgeon locates and removes the stone. Larger stones will be fragmented using ultrasonic, electrohydraulic, or laser treatment and the fragments will be removed. After the procedure a nephrostomy tube is left in the kidney for drainage of urine for one or two days.
- Minimal incision
- Direct visualization and removal of stones
- Short hospital stay
- Clearance of stones in over 90 to 95% cases in single session
Some risks and complications associated with PCNL are mild bleeding, infection, perforation, injury to nearby organs and urine leakage.