The urinary system consist of kidney, ureter and bladder (KUB). Stone is generally formed in kidney by aggregation of small crystals in kidney PCS and from there may migrate in ureter or bladder.
Type of endoscopic stone surgeries are decided on the basis of stone present in different sites of urinary system.
Renal Stone (kidney stone)1. Percutaneous cystlithotripsy (PCNL)
In this method of kidney stone removal, a small button size hole is created in the back and kidney is accessed. Throgh this passage, kidney stone is approached and with LASER energy stone is fragmented in small pieces and then all pieces are removed by grasping forcep.
2. Mini PERC
This procedure is similar to PCNL but here access hole is very small. Risk of bleeding is very much minimized, however is suitable for smaller size stone.
3. Retrograde intra renal surgery (RIRS)
In this surgery, the renal stone is accessed through urethra and ureter (retrograde). The stone is fragmented in very small pieces which pateint can pass in urine. This again is suitable for small bulk stone.
4. Extracarporeal shock wave lithotripsy (ESWL)
In this procedure, shockwaves are targeted over the stone. The stone gets fragmented in small pieces and the patient passes these fragments in urine. Usually this does not require anaesthesia and is an OPD procedure. Some times, DJ stenting is advised before the ESWL to avoid pain during passage of the stone fragments.
Ureteric Stone1. Rigid ureterolithotripsy (URS L)
In this procedure, a small size ureteroscope is passed in ureter through urine passage (urethra). The stone is located and fragmented with intracorporeal lithoclast in small pieces. All the fragments are removed with grasping forceps. Usually after the procedure D J stent is kept.
2. Flexible ureterolithotripsy (URS L)
When the stone is very high in position in ureter and rigid ureteroscope some times can not be negotiated up or there is risk of migration of stone in kidney with irrigation flow, in such case a very delicate thin instrument(Flexible Uretroscope) is used. This increases success rate of stone removal.
Bladder Stone1. Trans urethral cystolithotripsy (TUCL)
In this procedure, a endoscope is put in urinary bladder through urine passage (urethra). The stone is fragmanted by lithoclast and all fragments are washed out.
2. Per cutaneous suprapubic cystolithotripsy (SPCL)
When urethra is narrow like in children or stone bulk is high, the bladder is accessed through abdominal wall by making a small hole in suprapubic region.Through this passage stone is fragmanted in small pieces and removed.
Prevention of Urinary StoneTreatment of urinary stone is never completed without adopting strategy to prevent stone recurrence. Usually we send stone analysis to know the type of stone composition. The chemical composition could be calcium oxalate, struvite, uric acid, or other compounds. According the stone chemical compostion, dietry restrictions and medicine can be offered to prevent stone recurrence.
The universal stone prevention methods are high fluid intake and to avoid high dietary intake of animal protein, sodium, refined sugars, oxalate rich food and carbonated cola drinks.
Dr Amit K. Devra is one of the poineer endoscopic urology surgeon in Noida & Ghaziabad with more than thousands of successful endoscopic urinary stone surgeries. In his experience of more than 15 years, he has managed many complex and complicated cases referred from many peripheral centers.
- Pain in the back, belly, or side(Flank)
- Pain or burning during urination
- Urgence & frequence of Urination
- Blood in the urine
- Cloudy or smelly urine
- Nausea and Vomiting
- Fever and chills
- Endoscopic Removal of Kidney Stones
- Holmium Laser Lithotripsy using Flexible Uretero-Renoscope.
- MINI-PERC and MICRO-PERC -It is a further Miniatarisation/Smaller version of PCNL
- Percutaneous Nephrolithotomy (PCNL).
- RIRS (Retrograde Intrarenal Surgery) with Holmium Laser.
The Benefits of Endoscopic Surgical Procedures Can Include:
- Small incisions or few incisions
- Less pain
- Low risk of infection
- Short hospital stay
- Quick recovery time
- Less scarring
- Reduced blood loss