Kidney stones, most commonly known as renal calculi, are the hard masses of salts and minerals in the kidneys that result in excruciating pain around the abdominal region. Kidney stone is one of the most common diseases in the world, with an estimated global prevalence of around 12%.
However, with the technical advancements of different surgical equipment over the years, the clinical approach for renal stones presently revolves mostly around minimally invasive techniques. These techniques have paved the way for doctors to treat renal stones with more precision and provide different surgical options to patients that suit their medical conditions and preferences.
While most cases of kidney stones develop in people aged between 20 to 49 years, it is also observed that the peak incidences occur in individuals aged between 35 to 45 years. However, kidney stones can affect anyone at any age.
In India, it is estimated that approximately 12% of the population has urinary stones, out of which 50% have a chance of suffering from kidney damage. Renal stones are more prevalent in women with a probability of 56% as compared to 46% in men.
Many factors can result in kidney stones, such as heredity, obesity, dehydration, excess consumption of animal protein and calcium supplements, etc. In addition, prolonging the treatment can result in serious complications, including kidney failure, hydronephrosis, etc.
Therefore most urologists often recommend kidney stone treatment regardless of the size. Currently, there are four surgical procedures to treat kidney stones – PCNL, RIRS, ESWL, and URSL.
Modern surgical procedures for kidney stones v/s conventional open surgery
The conventional surgical procedure to remove renal stones required patients to undergo open surgery. Urologists often recall they had to routinely ‘cut for the stone’ in order to surgically treat the disease. The open procedure involved a large incision around the side or back of the abdomen that not only prolonged the recovery time but also increased the risk of post-surgery complications.
The surgical treatment of urolithiasis (kidney stones) has significantly changed over the past decades. For example, conventionally, when the stone pieces were not entirely removed from the body, the patient had to undergo another open surgery to remove the stones.
Currently, ESWL (Extracorporeal Shock Wave Lithotripsy) offers a surgical option to expel the stone fragments out of the body through urine by means of external shockwaves that break the stone into smaller pieces without any incision. You may require multiple sittings depending on how stubborn your stone is. Open surgery for most renal stones is currently limited to only complicated cases and patients’ preferences.
RIRS (Retrograde Intrarenal Surgery) & URSL (Ureteroscopic Lithotripsy) procedure
The open surgical method is surpassed by more advanced procedures like RIRS and URWL. These non-invasive methods efficiently remove stones stuck in the upper ureter, calyx, or if the stone is identified as staghorn calculi. Unlike conventional surgeries where the probability of recurrence of stones was significantly high, RIRS and URSL have almost no chances of recurrence.
The surgeons use a long, thin tube called a ureteroscope that is inserted through the urethra and into the ureter to locate and remove the stones. It is important to ensure the complete removal of stones from the body to avoid any chances of recurrence. This is achieved by inserting DJ (Double J) stents through the urethra before the surgery.
The purpose of the DJ stent is to enlarge the passage of the ureter to allow the smooth movement of stone fragments. Once the stone pieces are flushed out of the body, the urologists remove the stents from the body. Stents are usually removed on the same day of the surgery or during the consecutive visit to the surgeon. However, in some cases, it may even take weeks.
PCNL (Percutaneous Nephrolithotomy/Nephrolithotripsy)
Similarly, PCNL or percutaneous nephrolithotomy/nephrolithotripsy is deemed one of the most advanced treatment methods to remove large kidney stones that would be impossible to pass through urine. This method provides minimal incisions around the flank area (just below the lower back) to remove the stones that are larger than 1.5cm.
After the patient is sedated, the urologist uses an advanced scope called a nephroscope to locate and remove the stone. If the stone is removed in its intact form, it is called nephrolithotomy, but if the stone is broken into smaller pieces and vacuumed out, it is termed nephrolithotripsy. PCNL ensures the complete removal of renal stones to avoid recurrence in the future, along with a very high success rate.
Advantages of modern procedures for kidney stones surgery.
Advanced kidney stone surgeries offer a modern approach for different surgical procedures for different sizes of stones. All the surgical procedures including PCNL, ESWL, URSL, RIRS offer certain benefits due to the minute nature of incision(in case of PCNL) or advanced equipment that ensures a high success rate and faster recovery. Some of the advantages of advanced kidney stones surgeries are –
- Minimal incision (size of a keyhole)
- Minimum blood loss
- Negligible pain
- Almost no chances of recurrence
- Faster recovery
- The chances of complications are almost zero.
- Patients can return to their normal routine within a week after consulting the doctor.
- 1-day hospital stay
There has been a drastic change in the demographics involving the surgical procedures for kidney stones. Earlier, patients had to undergo immense labor for the surgery of stone as small as 6mm which is now treated without making a single incision. Technology has definitely paved the way for modern tools and techniques that not only ensure a smooth experience during the surgery but have also almost nullified the post-recovery complications. Modern surgical procedures offer minimal blood loss and ensure a faster recovery, therefore, proving to be one of the most reliable options for kidney stones treatment.