Laser Kidney Stone Treatment

Depending on the size, number, and location of the stones, there are four different methods for kidney stone removal surgery. When medications do not work against kidney stones, these treatment methods are recommended. The following surgical methods are used to remove kidney stones –

1. ESWL ( Extracorporeal Shock Wave Lithotripsy )

Prior to the procedure, the doctor administers spinal anaesthesia to the patient. However, the choice of using anaesthesia or not is ultimately up to the patient. Next, the patient is positioned on a water-bed cushion, as this serves as a protective barrier between their organs and the lithotripter machine. Once the exact location of the stone is determined, precise high-energy shock waves are released by the surgeon in a series to effectively break down the renal stones into smaller pieces.

As the stone pieces are flushed out of the body through urine, shockwave lithotripsy results in faster recovery since no cuts or stitches are used. For large kidney stones, ESWL is usually not recommended since it may take multiple sessions to break them completely. For large stones, the surgeon may also insert an ureteral stent to reduce the pain during stone expulsion.

2. URSL ( Ureteroscopic Lithotripsy )

Under spinal or general anaesthesia, the surgeon inserts a thin, long fibre-optic ureteroscope through the urethra and locates the stones using external x-rays.

The stone fragments are collected in the stone basket and removed from the body. The remaining stone fragments are flushed out through urine once the stone is located. It is either broken into smaller pieces with the laser or removed in its intact form. It is possible for the surgeon to use ureteral stents to flush out the stones in the body. By expanding the ureter, stents make it easier for stone fragments to pass through and out of the body.

3. RIRS ( Retrograde Intrarenal Surgery )

In order to reach the urine-collecting part of the kidney, the surgeon uses a long, thin flexible endoscope inserted into the urethral passage before administering spinal or general anaesthesia to the patient.

In order to achieve accuracy in RIRS surgery, the surgeon utilizes x-rays and image screening to produce real-time visuals of the kidneys on an external monitor. The endoscope is then retrogradely manoeuvred towards the location of the stone. Once the desired position is reached, a sophisticated holmium laser is employed to target and disintegrate challenging stones, without causing harm to adjacent organs. The resulting pieces are retrieved with a stone basket or, if necessary, removed intact using delicate forceps.

The surgeon can utilise stents, which are flexible tubes that run from the kidneys to the ureter, to widen the ureteral passage and facilitate the smooth removal of stone fragments from the body. These stents will be removed once all stones have been successfully flushed out, typically within 10 to 14 days. The continuous improvement of medical tools and equipment such as wires, ureteral access sheath, and stone containers has greatly enhanced the effectiveness of RIRS procedures.

4. PCNL ( Percutaneous Nephrolithonomy )

Under x-ray guidance, the surgeon inserts a thin, flexible nephroscope through an incision in the flank area (lower back) to visualise the stones and determine their exact location after the anaesthesia is given. The next step is to carefully dilate the urine collection system of the kidneys using a thin needle. This is accomplished by using a guidewire that allows the nephroscope to reach the kidneys safely.

Depending on the stone's size, the surgeon may either break it down into smaller pieces or remove it in its intact form with microforceps. DJ stenting may be required in some cases in order to flush out the stones through urine. Ureteral stents are thin, hollow tubes that are inserted into the urethral opening to reach the kidneys. Depending on how long it may take for stones to completely flush out of the system, they may need to be kept for about 10-14 days.