Kidney stones constitute one of the commonest diseases in our country and pain due to kidney stones is known as worse than that of labour pain. In India, approximately 5 -7 million patients suffer from stone disease and at least 1/1000 of Indian population needs hospitalization due to kidney stone disease.
It has been said that “once a kidney stone former, always a kidney stone former”. Once a kidney stone has been diagnosed, the choice is between expectant treatment and more aggressive forms of treatment, such as transurethral, percutaneous, or opens surgeries or extra corporeal modalities. Although some kidney stones may pass spontaneously and unless complicating conditions arise, surgical intervention may not be necessary. Thus, identification of kidney stones that are likely to pass is of utmost importance.
The primary decision is whether to apply surgical treatment or wait. Removal of kidney stones by any methodology is necessary when there is evidence of :
Most kidney stones of small size pass spontaneously in the urine without any need for intervention. The probability of a kidney stone passing down spontaneously will depend upon the size of a stone, its location, shape etc. Such patients are treated symptomatically.
Extra Corporeal Shock Wave Lithotripsy (ESWL) is a preferred mode of treatment for kidney stones upto 1.5 cm in size. An IVU is done prior to ESWL treatment to confirm the open passage from kidney to bladder for the finer fragment to pass out after a successful ESWL treatment. ESWL machine uses highly focussed sound wave projected from outside the body to break kidney stones. The stone is generally reduced to sand like particles which subsequently passes out in the urine. More than 1.5 cm to 2 cm stones generally requires more than one or two ESWL treatments.
The primary decision is whether to apply surgical treatment or wait. Removal of kidney stones by any methodology is necessary when there is evidence of obstruction. A Double J Stent insertion becomes mandatory in most of the cases.
PCNL treatment is for a larger stone which are not indicated for treatment by ESWL. This procedure is generally done under general anaesthesia, spinal and /or epidural anaesthesia. In this technique the stone is removed by making a small tunnel into the kidney from the back. A fine needle is used to puncture the renal collecting system with the aid of X-ray and/or Ultrasonography, and a guide wire is led into the kidney through the needle. This tract is dilated over the guide wire and a Nephroscope (kidney telescope) is inserted into the pelvis of the kidney. The stones are visualized, fragmented using Swiss Lithoclast or laser and extracted using fine forceps, allowing the kidney to become free of stones at the end of the operation, in the vast majority patients.
This is of course an operation, needing full general anaesthesia, average 90 minutes of operation time, 3-4 day hospitalization, and an occasional need for blood transfusion. Patient returns to light work in 5-7 days’ time. Nevertheless, the operation is safe, for both the patients and the kidney. This operation has really reduced the need for open surgery (cutting surgery), which is now reserved for exceptional indications.
This Percutaneous Nephrolithotomy (PCNL) technique is used to treat kidney stones of: