The treatment of renal lithiasis depends largely on the size, location and number of stones in the urinary system. Fortunately, most of the small kidney stones (5 mm diameter or less) do not cause symptoms and infections and will disappear if the patient drinks great amounts of fluids every day. The consumption of two to three liters of water increases the production of urine, which eventually will eventually drag the kidney stones in the system. Once they have come out, you do not need any other treatment. The doctor will usually ask the patient to keep the stones that were removed for analysis.
In addition, renal colic i.e. the sudden pain in the sides that occurs when the small stones begin to move down the ureter, can usually be treated with rest and analgesics or pain relievers. Certain types of stones, like those formed by uric acid, can be dissolved with medical treatment. However, the majority are composed of calcium and do not respond to medical treatment.
Surgery may be required if a stone:
- Does not drop
- Is greater than 8 mm
- Obstructs the flow of urine
- Is accompanied by a concomitant infection
- Damages the renal function
- Keeps growing
Until recently, surgery to remove stones was very painful and required a long recovery period. Nowadays, the treatment of these stones has dramatically improved and there are many options thanks to the Endourology (minimally invasive surgery inside the urinary tract).
Ureteroscopy is performed using ureteroscopes i.e. small flexible or semi-rigid telescopes that can be inserted through the urethra and the bladder until the ureter without any need to make incisions. Ureteroscopy was developed in the 1970s and began to be widely used in the 1980s. These instruments allow the doctor to view the ureteral stone directly. They have small working channels through which it is possible to switch devices to remove or fragment the stone.
It is usually performed under general anaesthesia and an endoprosthesis (double-J catheter) is left in the ureter for a few days after the procedure.
The risks of ureteroscopy include the drilling or development of a stricture (scar tissue), especially if the calculation was impacted in the ureteral wall. Most of the ureteroscopic procedures may be performed on an ambulatory basis in the USDS.
Extracorporeal Shock Wave Lithotripsy (ESWL)
This treatment with shock waves uses a machine called a lithotripter. The extracorporeal shock wave lithotripsy fragments the stones in pieces small enough to be removed during urination. The lithotripter produces shock waves, and the doctor, using ultrasound or x-rays, directs the waves exactly on the kidney or ureter inside the patient’s body. Waves travel easily through water and soft tissues of the patient’s body, until you reach the stone. The new shock waves will eventually break the stone into small parts.
Since the procedure can cause discomfort, the patient needs general anaesthesia, or some form of sedation. It may also be necessary to insert a stent (double-J catheter) temporarily through the urethra and bladder and into the ureter. It may be necessary to repeat the ESWL session.
ESWL is not the ideal choice of treatment for all patients. Pregnant patients or patients who have abdominal aortic aneurysms, infections of the urinary tract or uncorrected bleeding disorders must not be subjected to ESWL. In addition, some factors such as the size of the stones, its location and composition may require other alternatives to remove it. Although ESWL is considered as a safe and effective procedure, it can also cause complications. The majority of patients urinate blood during a few days after treatment.
Percutaneous nephrolithotomy (PCNL)
This procedure is the treatment that is used for kidney stones larger than 2 cm and that are found in places that do not allow ESWL to work effectively. In this procedure, the surgeon makes a tiny cut in the area of the side and then uses an instrument called Nefrosis Amiloidea to locate the stone and remove it. For larger stones, it may be necessary to use an energy probe (ultrasonic, electro-hydraulic or hydraulic) to break the stone into smaller parts.
Diagnostic and therapeutic alternatives
Diagnostic and therapeutic alternatives available in CUMQ are:
- Metabolic evaluation of the lithiasis
- Flexible and rigid ureterorenoscopy assisted by Holmium laser
- Retrograde intrarenal surgery (RIRS) assisted by Holmium laser
- Percutaneous nephrolithotomy