PCNL

Percutaneous nephrolithotomy or PCNL is a very effective procedure to remove stones of the kidneys. This procedure is particularly used when the stones are very large and are unable to pass on their own. In the PCNL method, the surgeon makes a small incision on the back of the patient to access the kidney and remove the stone or stones. This form of stone management is ideal for stones that are larger than 2cms in diameter or are very dense and hence, are not suitable for other methods.

What is PCNL?

PCNL is a great way to treat kidney stones via a minimally-invasive technique. In this method, a flexible tube is inserted into the kidney of the patient with the help of X-ray images. The tube is inserted by making an incision on the back of the patient. After the tube is put in the right place, a telescope is used made to pass through the tube to obtain a better view of the stone or stones.

For stones that are too large, a lithotripter is used to break them into smaller stones before they are removed through the PCNL procedure. Generally, a PCNL technique is considered very safe for stone removal and also has minimum post-operative complications. Moreover, this method has shorter recovery time and also does not require the patient to stay in the hospital for a long period. 

This method is particularly useful when large kidney stones tend to cause a lot of complications, such as restricting one or more collecting branch of the kidney. In cases, where the patient has a large stone in the ureter and other therapies have failed to provide results, a PCNL procedure can be used to provide relief.

What is PCNL MINI-PERC?

Another method which is less invasive than a PCNL procedure is a Miniaturized Percutaneous Nephrolithotomy (PCNL) (MINI-PERC). This method overcomes the disadvantages of a PCNL technique and hence, provides improved results. A MINI-PERC involves performing the PCNL procedure in one step by using a 16 G micro-puncture needle. In a further advanced version of this method, the surgeon uses an 8 Fr sheath to insert ultrasonic energy to treat urinary tract stones, especially kidney stones. This method is more advantageous as compared to a PCNL procedure. However, it is not very popular and widely used. Some of the major advantages of a MINI-PERC against a PCNL include low risk of haemorrhage, low postoperative pain, faster recovery, and shorter hospital stay. 

Why is PCNL done?

A PCNL procedure is performed on patients that have the following conditions:

  • Kidney stones those are difficult to remove because of their size being larger than 2cms in diameter.
  • Complications arising due to the presence of large kidney stones. These problems can range from mild to severe ones such as a blockage in one or more of the collecting branch of the kidney.
  • Existence of large stones in the ureter.

Moreover, a PCNL is best recommended for patients to who all other stone removal methods have failed to provide any relief. That said, before recommending a PCNL method, the doctor performs necessary blood and urine tests to assess the present health condition of the patient. Also, a CT scan can help understand the problem in-depth, including the size of the stone, the exact location, condition of the surrounding organs, etc.

What are the complications involved in PCNL?

Generally, PCNL surgery is very safe and does not have significant risks and complications. However, in some cases, the surgery might have the following risks:

  • Bleeding
  • Infection at the site of incision
  • Damage or injury to the nearby organs and tissues
  • Damage to the kidney
  • Incomplete removal of kidney stones

Additionally, in some cases, there is also a chance that the patient might require open surgery even after a PCNL procedure. This happens in circumstances when the surgeon cannot reach the stone in the kidney due to certain uncontrollable reasons.

What is the procedure of PCNL surgery?

Before beginning the procedure, the doctor administers the patient with anaesthesia. After this, a small incision is made on the back of the patient to access the kidney stone. The doctor passes a small, flexible tube through this incision into the kidney with the help of X-ray images. Once the tube is placed in the kidney, the surgeon passes a telescope through it to get a clear view of the stone and determine its exact size. It is also helpful in breaking the stone and then removing it from the body.

For patients that have very large stones, the PCNL surgery will involve using a lithotripter first to break the stones into smaller pieces. After which, they are successfully removed. Typically, a PCNL surgery takes about three to four hours, has minimum post-operative risks, faster recovery, and a shorter stay in hospital as compared to an open stone removal surgery. Moreover, a PCNL surgery has been more successful till now as compared to an extracorporeal shock wave lithotripsy (ESWL).

Overall, PCNL is a very widely used technique to remove large kidney stones, especially for patients who have not benefitted from other treatments.

ESWL

Extracorporeal shock wave lithotripsy or ESWL is a medical procedure to treat kidney stones. This method uses high-energy shock waves to break the larger kidney stones into smaller crystals, for easy removal through the urine.

What is ESWL?

Extracorporeal implies outside the body. In this method, the healthcare provider uses an instrument called a lithotripter to direct high-energy sound waves specifically at the stones, causing them to break into smaller pieces. The basic advantage of this type of ESWL procedure is that it does not cause any damage or harm to the surrounding tissues and organs. This is because the energy is directly focused at the stone, via external shock waves which travel into the body from the skin and tissue.

Once, the stones are broken into smaller pieces, they eventually pass on their own through urine over several days or weeks. The procedure is only about an hour long and is non-invasive. Therefore, there is a shorter hospital stay and a very fast recovery rate.

How to prepare for ESWL?

Before the procedure, the patient must discuss with the doctor about any ongoing medications, specific health conditions and other over-the-counter medications being taken. The doctor will advise non-usage of some specific medicines to prevent any complications from ESWL.

In many cases, the doctor administers local anaesthesia to patients to numb the area and prevent pain. In most cases, the patients are given general anaesthesia, allowing them to fall asleep during the process. In the case of the latter, the patient will be advised to not eat or drink anything at least 6 hours before the scheduled procedure.

For a patient that is given general anaesthesia, they must ensure to be accompanied by friends or family while leaving the hospital. The effects of general anaesthesia can take some time to wear off and a person will not be allowed to drive in such a case.

What happens during ESWL?

ESWL is usually an hour-long procedure, allowing the person to go home the same day of the procedure. Before beginning, the patient will be asked to change into a gown and lie on an exam table for the examination. Then the patient is given sedatives and antibiotics, as needed.

After the patient is sedated, the healthcare provider sends high-energy shock waves through the skin until they reach the kidney stones. These external energy shock waves cause the large-sized kidney stones to break into smaller pieces. These pieces are then eventually flushed out of the system via urine in some days. The shock waves are directed to the exact spot of the stones with the help of the X-Ray machine.

After the procedure, the patient is observed for two hours for any complications or after-effects. In some cases, where the patient is not comfortable after the procedure or is facing any complication, the doctor might ask the patient to stay overnight for observation. However, once discharged, the patient needs to take 1-2-day rest and drink plenty of water to flush out the smaller stone fragments.

What are the risks of ESWL?

Even though ESWL is very safe, some risks can accrue. These include:

  • Internal bleeding
  • Blood transfusion
  • Infection
  • Kidney damage in rare cases where the stone fragments block the urine from exiting the kidneys
  • High blood pressure
  • Kidney failure (very rare)

Who should not undergo an ESWL procedure?

Despite being a very effective method for kidney stone removal, and ESWL procedure is still not recommended for patients below:

  • Pregnant women
  • Patients that take blood thinners or have bleeding disorders.
  • Patients that have a chronic kidney infection
  • Patients that an obstruction or a scar tissue in their ureter
  • Cases where a complete stone removal is required in one go
  • Patients that have kidney stones made particularly of a specific type of calcium and cystine. These types of stones cannot be broken down easily via ESWL.

Why is ESWL required?

ESWL is required in cases where the kidney stones are too large and hence, are incapable of passing on their own. Moreover, if the patient has excessive pain, infection, or the functioning of the kidney is threatened, the doctor may recommend an ESWL procedure.

Also, in cases, where the patient has only one kidney or has had a recent kidney transplant, an ESWL procedure can help remove stone more quickly.

What are the advantages and disadvantages of ESWL?

The most prominent advantage of the ESWL procedure is that it is non-invasive and removes the kidney stones without making any incision. This consequently reduces the hospital stay and recovery time of the person.

On the other hand, while the procedure can be very successful, in some cases, there might be multiple stone fragments still left in the body and again causing symptoms. In this case, the doctor may need to reperform the procedure or in a complicated case switch to an alternative form of treatment.

Moreover, the procedure can also cause some complications, which eventually fade or are easily treatable.

In all, ESWL is a safe and effective procedure; however, it is not suitable for all kidney stone patients. The suitability of the procedure is decided by the healthcare provider.

RIRS: Retrograde Intrarenal Surgery

RIRS or Retrograde Intrarenal Surgery is an endoscopic surgery performed to remove renal stones by reaching the kidney from the ureter. It is a very effective method to treat or manage urinary stones. Urinary stones are solid masses made of crystals which usually develop in the kidneys, though they can develop anywhere along the urinary tract – kidney, ureter, bladder and urethra. Depending on the location of the stone, the stones are referred to kidney stone, ureteral stone or bladder stone. Also, varying by the location of the stone, the process of stone formation is called urolithiasis, renal lithiasis or nephrolithiasis. These stones are formed due to excessive accumulation of certain minerals in the body and the lack of fluids to dissolve the accumulated minerals that can include calcium, oxalate and uric acid. Moreover, other factors such as poor diet, severe diarrhoea, excessive weight, family history or certain medications can also lead to the formation of stones along the urinary tract.

Procedure of RIRS

Before the procedure,the doctor will conduct to determine the position of the stones, the general health condition of the patient and the overall response to anaesthesia. These assessments will be made at least 2 weeks before scheduling a retrograde intrarenal surgery.Once, the tests are clear, the doctor will conduct the stenting process 2-weeks before the actual RIRS surgery.The stenting is done to allow easier access to the urteroscope to enter the kidneys, as the stents since ureteroscopy is already dilated. Moreover, on the day of the surgery, the patient is required to not eat or drink anything for at least 4-6 hours. 

To begin the surgery, the patient is given anaesthesia and the urologist uses an endoscope – a thin, flexible tube – toreach thebladder through the urethra. Once there, the endoscope is then further directed to the area of urine storage in the kidney.

In the RIRS procedure, the surgeon uses a viewing tube called fibre optic endoscope and a laser fibre – Holmium – to treat the renal stones. Once the large stone is removed, small fragments of the stones are taken off through stone baskets. In some cases, a stent may be pushed in the kidney to improve drainage. Post the procedure, the endoscope is crushed, blasted or evaporated by using a laser probe or can also be manually removed through forceps. The surgery is performed by a urologist who has specialized expertise in RIRS. The surgery does not involve any incisions and hence, has a very fast recovery time. With RIRS a vast majority of renal stones can be cleared without open surgery.

Purpose of RIRS

With the recent technological developments in the management of renal stones, RIRS has emerged as a very reliable, safe and efficient method. The main purpose of a renal stone treatment is to clear the stones completely with minimum morbidity – RIRS clears renal stones through flexible ureterorenoscopes and lithotripters including holmium laser, ensuring no trace of stones are left. Moreover, advancement in related equipment such as guide-wires, urethral access sheath and stone baskets have enhanced the effectiveness of the RIRS procedure. As of today, RIRS is a prime method of treatment for renal stones that are less than 2 cm and cannot be successfully treated via other methods. 

Suitability of RIRS

An RIRS procedure is best suited for cases where:

  • Earlier attempts to remove renal stones have failed
  • Stones are too large
  • There is a tumour in the kidney
  • There are strictures in the kidney
  • The patient involved is a child
  • The patient has bleeding disorders
  • The patient is obese
  • The patient has complex anatomical kidneys
  • The patient is on anticoagulants

Advantages of RIRS

Retrograde intrarenal surgery is one of the novel methods to treat renal stones. Some of the advantages of the RIRS method are:

  • Minimally invasive
  • Simple and quicker procedure
  • Shorter recovery time
  • Less painful
  • Less morbidity
  • Minimal bleeding
  • No risk to the renal tissue
  • Fewer complications

Risks of RIRS

Complications or risks associated with RIRS are fairly uncommon and occur only in very cases.

  • Fever
  • Flank pain
  • Urinary infection
  • Transient hematuria
  • Acute urinary retention
  • Ureteral pelvicalyceal abrasion
  • Fornix rupture
  • Ureter avulsion
  • Bleeding
  • Sepsis
  • Trauma to kidneys

That said, RIRS may not be a surgical option if the size of the renal stones is more than 20mm in diameter or there are several small stones, especially along the previous tubes or after urinary tract infections. Such cases are not the ideal situations for RIRS and can be treated better through a different method.

Overall, RIRS has established itself as a reliable and safe method of treatment for renal stones. The advantages of RIRS outweigh its disadvantages. It is a very feasible treatment option with high success rates and lower complications involved. However, the suitability of RIRS for a patient can be determined by medical professional only.

Effective Ways To Prevent Kidney Disorder

Effective Ways To Prevent Kidney Disorder

Date: 15th September, 2019

Kidneys are the filtration system of our body and very critical for our survival, however, they are often neglected and in a lot of cases, kidney diseases go undetected for a long period of time until they become very advanced requiring immediate medical attention. Some of the risk factors that can cause kidney disorders include diabetes, high cholesterol, high blood pressure, heart disease, and a family history of kidney disorders. People aged 60 years or above also have a high risk of developing kidney disorders. 

Most kidney disorders are not detected until they reach an alarming stage; however, a urine test or a blood test can indicate the functioning of the kidneys and could indicate kidney disorders. It is advisable to get regular check-ups done to detect kidney disorders early on and prevent them from intensifying. That said, it is important to prevent oneself from the basic causes of kidney disorders – diabetes, blood pressure, and heart diseases. Some of the effective ways to prevent kidney disorders are:

Follow a healthy diet

A large number of kidney disorders are caused because of unhealthy food choices such as oily food, junk food, fast-food, carbonated drinks, processed food, caffeine, sugary items, etc. Instead, focus on eating foods that are healthy for the whole body and especially the kidneys. Healthy food options include fresh fruits, green leafy vegetables, whole grains, low-fat dairy food, etc. You should aim to reduce your intake of salt and added sugar. On an average day, a normal person’s intake of sugar should be less than 10 percent of the total calories and sodium intake should be less than 2,000 milligrams. Also, avoid foods that are high in trans fat, saturated fats, and cholesterol.

Indulge in at least 30 minutes of daily physical activity

Just a healthy diet does not guarantee healthy kidneys, it is also important to burn the calories taken from food daily to avoid build-up of fat. Exercise is essential to keep the body agile and functioning properly. A daily routine of exercise is essential for the health of blood vessels in the body. One can also start exercising for lesser time initially and then gradually increase. Simple healthy habits such as taking the stairs instead of the elevators also go a long way in preventing kidney disorders.

Maintain a healthy weight

Excessive body weight is a huge risk factor for diseases such as diabetes and high blood pressure, which in turn are the two most critical triggers for kidney disorders. Moreover, extra weight creates pressure on the kidneys to work harder and filter excessive waste above the normal level. Hence, it is important to maintain healthy body weight and stay fit. On a general scale, a BMI – Body Mass Index – of above 25 is considered to be alarming and indicates overweight. 

Get enough sleep

On an average, 7-8 hours of sleep is essential for a human body to stay fit and function properly. Lack of proper sleep is a major risk factor for diabetes and high blood pressure – both of which are prime causes of kidney disorders.

Quit smoking

Smoking is very harmful to the body and one must quit smoking to prevent kidney disorders. Smoking reduces the blood flow to major organs of the body including the kidneys, making their functioning hard. Also, smoking can impact the medications used to cure high blood pressure, causing uncontrolled blood pressure which ultimately worsens kidney disorders. More so, smoking causes higher levels of albumin and creatinine in their urine. Higher levels of albumin and lower excretion of creatinine from the body, is an indication of early kidney disorders and must be prevented.

Limit alcohol intake

Alcohol can disturb the normal process of the kidneys, making them less able to filter blood. Also, alcohol restricts the kidneys to maintain the right amount of water in the body by dehydrating the body. Excessive alcohol also affects the blood pressure, causing a shoot in the blood pressure which in turn harms the kidneys. Moreover, alcohol intake is known to adversely impact high blood pressure medications, creating an increased risk of kidney disorders. 

Reduce stress

Stress is a very common term today but often a silent killer in the generation. Stress and the reaction to it can adversely impact the health of the kidneys. Stress or hypertension is prime triggers for high blood pressure, which is a major factor affecting kidney health. Stress also affects the blood circulation and hampers the heart’s health – another risk area for the kidneys. Hence, it is critical to reduce stress in life to prevent kidney disorders. Indulging in hobbies, meditating, exercising, practicing yoga, etc. are several ways in which you can deal with acute stress. Moreover, you can also consult your doctor on ways to tackle the problem.

Apart from these important factors, it is also essential to keep certain things in mind while aiming to prevent kidney disorders. These include maintaining a positive outlook, setting time aside to relax, sharing feelings, and listening to music to calm the body and improvise its functioning. Moreover, it is critical to get tested regularly and consult your doctor on ways to keep your blood glucose, blood pressure and heart health in check, so that kidney disorders can be prevented rigorously.

Precautions To Be Taken After Kidney Stone Operation

Precautions To Be Taken After Kidney Stone Operation

A kidney stone is a solid mass composed of tiny crystals. These are formed when there is an excessive quantity of a certain mineral in the body while at the same time there is a lack of liquid to dissolve these minerals. These pebble-like objects are not actually stones but the pain caused is very intense and one might feel as if they are actually stones. These substances are yellow or brown in colour and are often smooth though they could be rough too. The most common types of kidney stones are calcium stones or uric acid stones.

Kidney stones can be the size of sand, gravel or the size of a pearl or even larger and is often very painful since it blocks the flow of urine. In many cases, the stone may travel through the urinary tract and come out but in many cases, small non-invasive surgeries may be required. While kidney stones are fairly common and can occur in both genders and people of all ages, it is vital to understand the causes of it, the symptoms to detect a stone, treatment and most important precautions to take after the kidney stone operation since, the stones have a tendency to reoccur if proper precautions are not taken.

Kidney stones are caused when there is a high level of certain minerals in the urine. These minerals generally include calcium, oxalate, and urine acid. When the concentration of these minerals in the body increases and there is a lack of fluids to dissolve the minerals, these turn and form into stones causing extreme pain and a lot of urine problems. Apart from this, some factors such as diet, extreme diarrhoea, obesity, family history or certain medications – can also cause stone formation. In many cases, people do not even realize the presence of stone in the body if they are really small – almost the size of a salt grain. Most people might not experience any symptoms of a kidney stone until the stone starts to stir and move around in the kidney or into the ureter.

That said, some of the common kidney stone symptoms include:

  • Intense pain on the side or below the ribs
  • Extreme pain in the groin and lower abdomen
  • Pain while peeing and increased frequency of pee
  • Pink, brown, red or cloudy pee
  • Nausea with stomach pain
  • Fever
  • Chills

The only effective way to avoid kidney stones is to evade the build-up of minerals by consuming a lot of water and fluids every day, as well as following a healthy and regulated diet with restricted sodium, exclusion of certain vegetables such as spinach. One should drink at least 8 glasses of water each day to meet the daily water requirements of the body. In many cases, kidney stones pass automatically and do not cause any problems. However, it depends on what the size and the symptoms of the problem are. That said, this is not a guaranteed method to get rid of kidney stones, the doctor might suggest certain medications and in extreme cases, might even suggest surgery. In cases, where a kidney stone operation is undertaken, it could either be:

Shock wave lithotripsy (SWL): Where high-energy sound waves are aimed to break down small or medium size stones into tiny pieces that can be released while urinating. 

Ureteroscopy: In this method, a thin, flexible tube is inserted through the urethra, bladder, and ureter to reach the stone and extract it. In cases of a larger stone, a laser is passed to break it.

Open surgery: When the non-invasive methods fail and the stone is large in size, the doctor might person an open surgery to remove the stone by cutting through the side to take the stone out while you are sedated.

No matter the form of procedure, there is a need to take extreme precautions post the kidney operation to ensure you are healthy, recovering well and there is no recurrence of the stones. Some of the procedures one must take include:

  • Do not drive back after the operation. Instead, ask someone to pick you up and take home from the hospital
  • Take enough rest and avoid any physical activity at least for 2-3 days. Even after this duration, if you do not feel energetic enough to take on normal routine activities, take some more rest
  • Drink a lot of water after the procedure an in the weeks to follow after the operation. Overall, maintain the quantity of 8 glasses of water each day
  • Take all medications as suggested by the doctor even if you tend to feel fine. Completing the full course is essential
  • Occasionally strain your urine to check for any stones. In case, there are any stones, get it checked via your doctor
  • East less salt
  • Reduce foods that are high in calcium
  • Drink fluids such as lemonades (without sugar), eat lemons and oranges
  • Do not consume a lot of protein, eat lean meats instead
  • Opt for a low-fat diet
  • Avoid alcohol
  • Avoid calcium supplements for some time and seek advice on when to restart the doses
  • Avoid high doses of Vitamin C supplements
  • Visit the doctor on all appointments as suggested

Further, one must consult the doctor about any precautions to follow post the kidney stone operation. Precautions might also vary condition on condition and proper consultation is very critical. However, in the general scenarios, one must carefully follow these rules to recover well after a kidney stone operation.

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