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Urinary stone disease is common in the United
States and throughout the world. There are many causes of stones
including dietary factors, environmental climate, several medical
conditions or diseases, and anatomical problems in the urinary tract.
Surgical intervention is commonly needed to relieve obstruction
when conservative observation is unsuccessful, or to correct anatomical
problems.
The least invasive way to treat stones is with extracorporeal
shock wave lithotripsy (ESWL). This is usually the first line
therapy for stones (less than 2 cm) in the renal pelvis and the
upper ureter. Its effectiveness is limited for larger stones and
stones in the lower ureter. Being least invasive, however, means
that patients have to pass stone fragments after shock wave lithotripsy.
An internal drain (a double-J stent) may be necessary in selected
cases (e.g. infection involved) to assure urinary drainage. Successful
treatment with shock wave lithotripsy is in the 60-80% range.
Endoscopic surgery uses
minimally-invasive means to treat stones. Over the past ten to fifteen
years, advances in fiberoptical and laser technology have provided
urologists with the means to treat stones virtually anywhere within
the urinary tract. Currently available endoscopes (such as those
used in the ureter or uretero-scopes) can be passed through the
natural pathway of the urinary tract to directly visualize stones
and to treat them by fragmentation and removal. Stones in the lower
ureter are commonly treated by ureteroscopy procedures as are stones
in the renal pelvis and upper ureter which are not successfully
treated by ESWL.
Percutaneous surgery
is done by obtaining access into the renal pelvis of the kidney.
These procedures are most often used in cases of larger stones (>
2 cm). These procedures are more invasive since the approach to
the kidney stones is created through the skin and muscle layers
of the upper flank, and eventually through the tissue of the kidney.
Contemporary series have reported blood transfusion rates up to
5-7%. Other adjacent structures such as the colon and the lower
aspect of the pleural (lung) cavity are also at risk for injury
in difficult cases.
Open surgery
for stones is used today as salvage procedures. Its invasiveness
and higher morbidity result in a significantly longer recovery time
for patients. It is mainly used today when the above techniques
fail or to repair complications of these techniques.
* This information is not intended to substitute for a consultation with a urologist. It is offered to educate patients on the basis of urological conditions in order to get the most out of their office visits and consultations. Please see our web page disclaimer for addition information. |
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