Kidney stone disease is relatively common in the U.S, affecting 1 in 9 persons during their lifetime. Over the past several decades, the prevalence increased significantly and more than doubled from the early 1990s to 2020s. Kidney stones are most likely to occur in the fourth to sixth decade of life but can happen in children and elderly patients as well.
Kidney stones are hard deposits made of minerals and salts formed within the collecting system of the kidney. They are typically made of calcium. Geographic areas with environmental risk factors for stone formation such as hot, dry climates have a higher prevalence of stone disease. This means people living in the Southern United States are more likely to develop stones than those in the north. Other risk factors for stone formation include obesity, diabetes (specifically insulin-resistance), hypercalciuria, and family history of kidney stones.
Symptoms of kidney stones include flank pain and hematuria (blood in the urine). Men can have testicular pain, and women can have pain in the labia. Kidney stones can also obstruct the ureter, leading to infections and diminished renal function.
Surgical Management of Stones
There are different ways to treat kidney stones. This depends on stone location and size, as well as some patient-specific factors. Dr. Shirin Razdan is fellowship trained in endourology and minimally invasive surgery and can perform kidney stone surgery with small incisions or even no incisions whatsoever.
What is Percutaneous Nephrolithotomy?
Percutaneous Nephrolithotomy (PCNL) is a minimally invasive treatment used for eliminating large kidney stones. A small dime-sized incision is made through the back, and a special scope is introduced directly into the kidney using ultrasound or x-ray guidance. After localizing the stone, pneumatic energy is used to efficiently break apart and suction the stone fragments out of the kidney. Typically patients are left with a stent to help drain any further small stone fragments in the urine. The stent then comes out in the office under local anesthesia. PCNL is preferred for patients with very large stone burdens in the kidney.
What is Ureteroscopy?
Ureteroscopy is a procedure that involves putting a small camera into the ureter and kidney through the urethra (the tube that carries urine from the bladder to the outside world). This involves no incisions on the body and is preferred for patients with ureteral stones or small kidney stones. After a stone is identified, a small laser fiber is used to blast the stone into tiny pieces that are then removed using a special basket extractor. After stone clearance, patients are typically left with a stent that is subsequently removed under local anesthesia in the office.
What to Expect with PCNL?
Most patients are admitted after surgery for close monitoring. They will have a urinary catheter draining urine from the bladder. This allows for careful measurement of urine output. This catheter is typically removed prior to discharge. Most patients go home within 24 hours. Patients will be discharged home with pain medication and antibiotics. It is normal to have blood in the urine and pass stone fragments and sediment in the urine after the surgery.
Avoid heavy lifting or exertion for 4 weeks after surgery. Light exercise can be resumed after two weeks. Drink plenty of water in the immediate postoperative period.
What to Expect with Ureteroscopy?
Ureteroscopy is an ambulatory procedure. Patients can go home same day with pain medication and antibiotics. It is normal to have blood in the urine and pass stone fragments and sediment in the urine after the surgery.
Avoid heavy lifting or exertion for 4 weeks after surgery. Light exercise can be resumed after two weeks. Drink plenty of water in the immediate postoperative period.
Why Dr. Shirin Razdan for Kidney Stone Eradication?
Dr. Shirin Razdan has an impressive track record of eradicating large stone burdens that cannot be treated with ESWL or ureteroscopy. Patients who couldn’t get cured with other treatment options in the past or failed to get the desired results through multiple surgical sessions do get benefit from PCNL.
FAQs
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What is the advantage of PCNL over other stone eliminating procedures?
PCNL has an advantage over other treatments such as ESWL or ureteroscopy in eliminating large stone burdens in a single setting.
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What are the risks of PCNL?
Like many other surgeries, PCNL too has risks involved, such as the possibility of an infection, bleeding, and other complications. This procedure involves creating a hole in the kidney, which heals on its own. Patients with prior abdominal surgeries will have a small risk of injury to organs located nearby (bladder, bowel, ureter, liver, spleen, etc.).
Patients on blood thinners are at higher risk for bleeding complications and must have multi-specialty discussion to determine PCNL vs. ureteroscopy for optimal and safe stone clearance.