Urinary Tract Stones
Stones are a common problem affecting the urinary tract. They commonly occur in the kidney or the ureter (the tube that conducts urine from the kidneys to the bladder) but can occur at other sites such as the bladder or urethra (tube through which we pass urine from the bladder).
These stones are ‘real’ stones just like the stones one sees in nature! Patients with stones commonly present with pain, blood in the urine, burning sensation in urine or fever. Rarely there may be no symptoms and the stone is identified incidentally on imaging done for some other problem. Confirmation of diagnosis may require various combinations of ultrasonography, X-rays, IVU (intravenous urogram) or CT scan.
Small stones may be managed by medication alone. Larger stones or those causing swelling in the kidney or infection need to be treated, sometimes urgently. Removal of stones can be accomplished by ESWL (extracorporeal shock wave lithotripsy), keyhole removal (PCNL), removal by ureteroscopy (URS) or rarely by laparoscopy. Small stones are well suited to ESWL which is non invasive although some patients may require the placement of a small tube in the kidney called a stent. Larger stones are best removed by PCNL or URS. A recent addition to the armamentarium for stone treatment has been the Holmium Laser Lithotripsy and Flexible Ureteroscopy. Holmium Laser offers the option of a delivery mechanism that is extremely precise and powerful, yet very slim (the smallest diameter laser fibers are 200microns in size) and flexible thus allowing it to be used through the flexible ureteroscope. Use of these technologies makes RIRS (retrograde intrarenal surgery) and mini-PERC (slim keyhole) stone removal feasible.
Large and complex stones (such as staghorn stones) can be removed by minimally invasive methods and have a large experience with the removal of such stones in normal or even congenitally malformed kidneys such as horseshoe kidneys or malrotated kidneys.
Dr Sanjay Sinha, MS,DNB,M.CH,MAMS
Urologist & Transplant Surgeon,
Apollo Hospitals, Hyderguda