Kidney stones | Kidney stone treatment in Bangalore

Kidney stones | Kidney stone treatment in Bangalore arise because crystals are formed in the urine. Not all kidney stones are painful. But when stones enter the ureter (kidney pipe) and make the flow of urine more difficult, they often cause severe pain called as a renal colic. Most of the patients we see report to the emergency department with severe pain, with or without nausea and vomiting.

Kidney stones  | Kidney stone treatment in Bangalore

Pain relief is the first step in treatment, often combined with medication that can relax the muscles of the ureter. Fluid intake is limited to limit the pressure on the drainage system. Further examinations are then planned, on the one hand to determine the location and size of the stone, and on the other hand to rule out complications.

On the basis of the results of these examinations and in consultation with the patient, the urologist will decide what the Best Kidney stone treatment in Bangalore could be.

Pain relief and waiting for the spontaneous expulsion of the stone: Especially for small stones that are already at the end of the ureter, often the best option

Preparation for the ultimate stone treatment or approach for complicated stones:

Some stones cannot be treated in 1 time due to their location, size or complications (infection, blockage in patients with only 1 kidney, ...). In these patients, a smooth passage of urine must first be guaranteed before the actual treatment of the stone can be started.

Ureteric stent: A Ureteric stent aka DJ stent is a hollow plastic tube with curls on both ends that helps to hold the stent in place. The stent is placed under anesthesia or sedation in the operating room. It passes through the ureter next to the stone and serves to drain “dirty” urine and relieve pressure on the kidney.

Nephrostomy: If placement of a DJ stent is not recommended or is not possible, a nephrostomy must be inserted. This is a drain that is done through a small incision in the back and into the kidney. This procedure can be done under local anesthetic at the radiology department.

Surgical treatment: For the definitive treatment of the stone, the urologist has 3 treatment options available:

ESWL = extracorporeal shockwave lithotripsy

URS (Therapeutic ureterorenoscopy)

PCNL = percutaneous nephrolitholapaxia

ESWL or kidney stone pulverizer

Sound waves are aimed at a focal point. Via X Ray imaging or Ultrasound imaging, the stone is searched and placed in the focus of the shock waves. The purpose of this is to break the stone, so that the pieces of stone can be discharged spontaneously.

 

Not all stones are equally hard, so that not all stones can be treated in this way. Large, hard stones require more energy, so that sometimes several treatment sessions are necessary. Stones in the ureter often break less well, regardless of size and hardness.

Usually 3000 shock waves / session are administered. These are rather painful and in order to focus properly, the patient must remain very still. That is why the procedure is performed under sedation or anesthesia. The patient enters the day hospital on an empty stomach for this purpose.

Although this procedure does not involve any cut on the skin, the shock waves can in exceptional circumstances give rise to bruising. It is therefore very important that the patient reports the use of blood thinners in advance.

Blood in the urine can occur after this procedure.

The fragment of the stone that settles after the procedure can give rise to a new renal colic. Measures here are similar to those for small stone treatment: pain relief as prescribed by the doctor and fluidrestriction. In case of fever or unbearable pain, the emergency department should be contacted immediately.

Ureterorenoscopy (URS)

During this procedure, the urologist uses a small camera through which a working channel runs through the urethra and the bladder to the ureter to search for the stone. Small stones can be caught and removed with a pair of forceps or a basket. Larger stones are fragmented with the laser into fine particles, which can spontaneously wash out. 

The procedure is always performed under general or regional anesthesia in a day hospital or with 1 overnight stay in hospital.

After surgery, many patients might have blood in their urine. Pain (colic pain) can also persist for several days due to swelling of the ureter. Pain relief is prescribed for this.

If the stone or procedure causes damage to the ureter wall, the urologist will leave a DJ stent until the ureter has healed. The stent gives the feeling of frequent and urgent urination. It often also causes blood in the urine (up to a few days after stent removal). The stent is removed after a week in the OPD.

In case of fever or pain that is not controlled with classic pain relief, you must report urgently, regardless of whether a stent was left or not.

Percutaneous Nephrolithotomy (PCNL)

This procedure is used less frequently than ESWL or URS. It is a technique to remove very large stones (> 2cm) from the kidney or the most upper part of the ureter.

During the procedure, a catheter with a balloon is first introduced through the urethra and the bladder into the ureter. Afterwards, the patient is turned on the stomach or on the side. The kidney is punctured through an incision in the back or in the flank, guided by the ultrasound. The resulting channel is stretched and a tube is pushed through which a camera with working channel is inserted into the kidney. Here the stone is usually broken into pieces with the laser or conventional lithotripter, which are then removed from the kidney with forceps. At the end of the procedure, a drain or catheter is inserted into the canal so that the bloody urine can drain properly. The blood remains in the urine for several days.

The procedure is always performed under general anesthesia and the patient is admitted to hospital for 3 to 4 days.

After the procedure, the patient is not allowed to do strenuous exercise or exercise for 3 weeks.

In case of pain, excessive blood flow or fever, the patient should immediately go to the emergency department

For more information about kidney stones, please consult Dr. Praveen B Joshi.